Key result
Carotid stenting and carotid endarterectomy demonstrated similar mean cumulative complication rates of myocardial infarction and stroke (8% vs 9%, respectively) in patients with carotid atherosclerosis.
Why the study?
Randomized trials comparing carotid artery stenting with carotid endarterectomy yielded conflicting data, and clear international guidelines for managing patients with multivessel lesions are lacking.
Does carotid artery stenting compared to carotid endarterectomy improve clinical outcomes in patients with carotid atherosclerosis?
Systematic Review (n=4,546)
Does carotid artery stenting compared to carotid endarterectomy improve clinical outcomes in patients with carotid atherosclerosis?
Absolute Event Rate: 8% vs 9%
Carotid stenting and carotid endarterectomy demonstrate comparable rates of cumulative complications (stroke and myocardial infarction), suggesting they are complementary rather than competing treatment strategies for carotid atherosclerosis.
Supports individualized procedural choice by anatomy and risk; confirms comparable safety across major randomized trials.
More than ten international randomized trials have been conducted to determine the effectiveness and safety of carotid artery stenting and comparing the latter with the results of carotid endarterectomy. However, some of them obtained conflicting data confirming both the advantage of carotid stenting (SAPPHIRE) and carotid endarterectomy (EVA-3S), as well as the equivalence of the two treatments (CAVATAS, SPACE, CREST). Also, unsatisfactory results of both single-stage and staged surgical approaches were shown in the treatment of patients with combined atherosclerotic lesions of the coronary and carotid arteries. The lack of clear international guidelines for the management of patients with lesions of several vascular beds makes it necessary to look for new methods of surgical treatment based on minimally invasive endovascular technologies. This review article analyzes the results of randomized trials comparing the results of carotid endarterectomy and carotid stenting in patients with carotid atherosclerosis.
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Abdurakhmanov et al. (2023) conducted a systematic review in Carotid atherosclerosis (n=4,546). Carotid stenting vs. Carotid endarterectomy was evaluated on Cumulative complication rate (myocardial infarction and stroke). Carotid stenting and carotid endarterectomy demonstrated similar mean cumulative complication rates of myocardial infarction and stroke (8% vs 9%, respectively) in patients with carotid atherosclerosis.
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