Comparative evaluation of carotid artery stent designs through a strict randomized evidence synthesis and assessment of local vascular responses

Carotid artery stenting is an established endovascular option for carotid stenosis, but comparative clinical evidence for individual stent designs remains limited. Full-text reassessment confirmed five independent trials that randomized patients specifically to a stent device or stent-design strategy. Only two trials (204 patients; four standardized events) provided fully verified arm-level data for stroke, transient ischemic attack, or all-cause death within 30 days. The device evidence formed a sparse chain without a closed loop, and each direct comparison was informed by one trial. Bayesian network meta-analysis, treatment ranking, and node-splitting were therefore not performed. Direct estimates were imprecise and did not establish superiority of any stent or structural class. The animal findings describe exploratory local vascular responses to geometry-matched miniature nitinol stents under controlled experimental conditions and do not validate a clinical device hierarchy. The chronological relationship between the clinical evidence review and animal study design is acknowledged as a limitation.