A Meta-analysis Comparing The Safety Of Carotid Artery Stenting Versus Carotid Endarterectomy For Asymptomatic Carotid Stenosis

Objectives: We performed a meta-analysis of recently published randomized controlled trials to evaluate the safety of carotid artery stenting(CAS)versus carotid endarterectomy(CEA)for asymptomatic carotid stenosis with average risk.Methods: The Medline,Embase,and Cochrane Library databases were systematically searched for randomized controlled trials that compared CAS with CEA for asymptomatic carotid stenosis.These publications reported clinical outcomes after revascularization in patients with asymptomatic carotid stenosis during their primary intervention.Endpoints(composite of ipsilateral stroke,any stroke,major stroke,minor stroke,myocardial infarction and death during a postprocedural period)were extracted from the publications by two reviewers.We calculated the pooled odds ratios(ORs)and 95% confidence intervals(CIs)concerning perioperative outcomes following CAS and CEA using a fixed-effects model.Results: Five studies involving 3901 patients(CEA,1585;CAS,2316)were included in the meta-analysis.The risk of any stroke during the periprocedural period was significantly lower in patients who underwent CEA than CAS(OR,0.53;95% CI,0.29–0.96).The difference between CAS and CEA in the rate of stroke could be driven by minor stroke(OR,0.50;95% CI,0.25-1.00).The risk of death,major stroke,ipsilateral stroke and myocardial infarction were not significantly different between the two interventions(periprocedural death: OR,1.49;95% CI,0.26–8.68;periprocedural major stroke: OR,0.69;95% CI,0.20-2.35;periprocedural ipsilateral stroke: OR,0.63;95% CI,0.27,1.47;periprocedural myocardial infarction: OR,1.75;95% CI,0.84–3.65).No robust conclusion could be drawn regarding mid-to long-term complications because of the heterogeneity of the reported data.The different outcomes precluding us from conducting any further analysis.Conclusion: Among patients with asymptomatic carotid stenosis,stenting has a significantly higher rate of any periprocedural stroke and periprocedural minor stroke than CEA,and similar risk of periprocedural major stroke,periprocedural ipsilateral stroke or myocardial infarction.