Meta-Analysis Comparing Carotid Artery Stenting with Endarterectomy for Asymptomatic Carotid Artery Stenosis

Carotid artery stenosis is responsible for 1/3 of cases of stroke annually. 1 Brooks WH McClure RR Jones MR Coleman TL Breathitt L. Carotid angioplasty and stenting versus carotid endarterectomy for treatment of asymptomatic carotid stenosis: a randomized trial in a community hospital. Neurosurgery. 2004; 54: 318-325 Google Scholar , 2 Brott TG Howard G Roubin GS Meschia JF Mackey A Brooks W Moore WS Hill MD Mantese VA Clark WM Timaran CH Heck D Leimgruber PP Sheffet AJ Howard VJ Chaturvedi S Lal BK Voeks JH Hobson 2nd, RW CREST InvestigatorsLong-term results of stenting versus endarterectomy for carotid-artery stenosis. N Engl J Med. 2016; 374: 1021-1031 Google Scholar , 3 Halliday A Bulbulia R Bonati LH Chester J Cradduck-Bamford A Peto R Pan H ACST-2 Collaborative Group. Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy. Lancet. 2021; 398: 1065-1073 Google Scholar Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are 2 established interventions for treating symptomatic carotid artery stenosis. Recently, the ACST-2 trial (Second Asymptomatic Carotid Surgery Trial) compared the 2 techniques among patients with asymptomatic carotid artery stenosis and showed similar postprocedural and long-term outcomes. 3 Halliday A Bulbulia R Bonati LH Chester J Cradduck-Bamford A Peto R Pan H ACST-2 Collaborative Group. Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy. Lancet. 2021; 398: 1065-1073 Google Scholar This refueled the heated discussion regarding the safety and efficacy of CEA versus CAS in patients with asymptomatic carotid artery stenosis. Hence, we conducted an updated meta-analysis of randomized controlled trials to evaluate the safety and efficacy of both procedures in this patient population.