Carotid Artery Stenting Versus Carotid Endarterectomy for Carotid Artery Stenosis: Systematic Review and Meta‐Analysis of Randomized Controlled Trials

ABSTRACT Background Carotid artery stenosis is a significant risk factor for ischemic stroke. Two primary interventions, carotid artery stenting (CAS) and carotid endarterectomy (CEA), are commonly used to prevent stroke. Aims This study systematically reviews and compares the efficacy and safety of CAS versus CEA in preventing stroke and other related outcomes. Methods A comprehensive search of medical databases such as MEDLINE, Web of Science, ScienceDirect, and Cochrane CENTRAL identified relevant studies comparing CAS and CEA. Meta‐analyses were conducted using a random‐effects model to pool risk ratios (RRs) with 95% confidence interval (CI). Heterogeneity was assessed using I ‐squared statistic and publication bias were assessed using Egger's test and funnel plot. Results CAS was associated with a significantly higher risk of stroke (RR = 1.490, 95% CI: 1.282–1.731, p < 0.001) and a borderline higher risk of restenosis (RR = 1.257, 95% CI: 1.000–1.578, p = 0.050) compared to CEA. However, CAS had a significantly lower risk of myocardial infarction (RR = 0.476, 95% CI: 0.341–0.664, p < 0.001) and cranial nerve palsy (RR = 0.079, 95% CI: 0.042–0.149, p < 0.001). No significant differences were found in all‐cause mortality, TIA, or pulmonary embolus between CAS and CEA. Conclusion While CAS reduces the risk of myocardial infarction and cranial nerve palsy, it is associated with a higher risk of stroke and restenosis compared to CEA. These findings highlight the importance of individualized treatment decisions based on patient risk profiles.