Carotid Stenosis and Outcome: Scoping Review with ☸️SAIMSARA.

Name: SAIMSARA Evidence Object vascular::CAROTID_OUTCOME_SS
Creator: SAIMSARA
License: https://saimsara.com/license/

SAIMSARA

doi:10.62487/saimsara3a2e7f50

SAIMSARA Journal

Machine-Readable Science • ISSN 3054-3991

Carotid Stenosis and Outcome: Scoping Review with ☸️SAIMSARA.

Cardiac & Vascular Health

Issue 1, Volume 1, 2026

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DOI: 10.62487/saimsara3a2e7f50

Editorial note

• Last update: 2026-03-21 21:49:22

What is this paper about

Carotid stenosis outcomes are not determined by narrowing alone: this review shows how symptom status, procedure choice, restenosis, and plaque vulnerability markers can decisively shift stroke risk and long-term prognosis. Read the full paper to see which patients appear to benefit from intervention, where CEA and CAS truly diverge, and why modern risk stratification may need to move beyond luminal stenosis.

Abstract: This paper aims to synthesize the current evidence on the outcomes associated with carotid stenosis, encompassing the natural history of the disease, the efficacy and safety of revascularization strategies, and factors influencing patient prognosis. The review utilises 199 original studies with 1448562 total participants (topic deduplicated ΣN). Across the mapped evidence, outcomes in carotid stenosis consistently varied by symptom status, stenosis severity, and treatment strategy, with particularly clear signals in comparative revascularization research. In asymptomatic high-grade disease, one trial-level signal indicated lower 4-year stroke or death with stenting added to intensive medical therapy (2.8% vs 6.0%), while contemporary cohort data suggested low 10-year stroke incidence in moderate asymptomatic stenosis (2.0%), underscoring the need for better risk stratification beyond luminal narrowing alone. For symptomatic stenosis, long-term comparisons repeatedly indicated that CEA tends to have more favorable stroke and restenosis profiles than CAS, even when disabling or fatal stroke risks converge over longer follow-up, and restenosis after stenting was linked to higher subsequent ipsilateral stroke risk. The evidence map also highlights that plaque vulnerability markers (e.g., inflammation and neovascularization) and post-procedural MRI lesions are not merely descriptive findings but are associated with future cerebrovascular risk, supporting a practical shift toward integrating plaque biology into decision-making alongside procedural risk and timing considerations. Future research should focus on prospective, standardized, subgroup-specific studies that combine modern medical therapy with validated imaging/biomarker risk stratification to identify which asymptomatic and moderate-stenosis patients derive net benefit from intervention and which are best managed medically.
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Keywords: Carotid stenosis; Ischemic stroke; Carotid endarterectomy; Carotid artery stenting; Stroke risk; Perioperative outcomes; Asymptomatic carotid stenosis; Symptomatic carotid stenosis; Medical management; Plaque vulnerability

Review Stats

Final search date and database lock: 2026-03-20 14:36:10 CET
Plan: Pro (expanded craft tokens; source: Semantic Scholar)
Source: Semantic Scholar
Total Abstracts/Papers: 6135
Downloaded Abstracts/Papers: 1000
Included original and non-original Abstracts/Papers (all): 247
Included original Abstracts/Papers (Vote counting by direction of effect): 199
Reference Index (links used in paper): 77
Total participants (topic deduplicated ΣN): 1448562

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Reference Index (77)

[1] Clinical features, radiological findings, and outcome in patients with symptomatic mild carotid stenosis: a MUSIC study. — https://doi.org/10.3171/2024.10.jns241185
[2] Determinants of prehospital and in-hospital delay in patients with symptomatic carotid stenosis and their influence on the outcome after elective carotid endarterectomy — https://doi.org/10.1136/svn-2024-003098
[3] Prevalence, predictors and outcome of carotid stenosis: a sub study in the Preventive Antibiotics in Stroke Study (PASS) — https://doi.org/10.1186/s12883-020-02032-4
[4] Impact of carotid stenosis on the outcome of stroke patients submitted to reperfusion treatments: a narrative review — https://doi.org/10.1515/revneuro-2024-0002
[5] Medical Management and Revascularization for Asymptomatic Carotid Stenosis. — https://doi.org/10.1056/nejmoa2508800
[6] Optimised medical therapy alone versus optimised medical therapy plus revascularisation for asymptomatic or low-to-intermediate risk symptomatic carotid stenosis (ECST-2): 2-year interim results of a multicentre randomised trial. — https://doi.org/10.1016/s1474-4422(25)00107-3
[7] Sex differences in Outcome after Carotid Revascularization in Symptomatic and Asymptomatic Carotid Artery Stenosis. — https://doi.org/10.1016/j.jvs.2023.03.502
[8] Carotid Stenosis and Recurrent Ischemic Stroke — https://doi.org/10.1161/strokeaha.121.034089

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