Mid-Term Meta-Analysis Results of Carotid Artery Stenting and Carotid Endarterectomy Based on Randomized Controlled Studies

Objective: A comprehensive of published randomized controlled trials (RCTs) was performed to evaluate the mid-term safety of carotid artery stenting (CAS) versus carotid endarterectomy (CEA) for both asymptomatic and asymptomatic carotid stenosis. Material and Methods: In this research, trails published from 1994 until December 31, 2021 was performed using ScienceDirect, Pubmed, Web of Science, Sage, Ebscohost, Scopus and Cochrane Central electronic databases. Major end points (any stroke, myocardial infarction, and all-cause mortality) were extracted from the publications. We calculated pooled risk ratios (RRs) and 95% confidence intervals (CIs) using a fixed-effects model. The Q and I2 statistic were used as a measure of heterogeneity. Results: Twelve trials involving 8,301 (4,498 with CAS; 3,803 with CEA) patients were included in the meta-analysis. When compared with CAE, stenting was associated with a significantly increased risk of mid-term any stroke (RR=1.397; 95% CI: 1.159-1.684; p<0,001) but a significantly decreased risk of mid-term myocardial infarction (RR=0,487; 95% CIs: 0.302-0.786; p=0,003). No difference was found in mid-term allcause mortality (RR=1,009; 95% CIs: 0.904-1.126; p=0,869) between the 2 interventions, yet with a minor trend toward superiority favoring CEA. No evidence of significant heterogeneity was found in any of the analysis. Conclusion: CAE was found to be superior to stenting in term of any stroke, whereas CAS was associated with a lower risk of mid-term myocardial infarction. But for robust results, further studies are needed to address the relative effectiveness of CAS versus CAE in the future.