This paper shows that the choice between carotid endarterectomy and carotid stenting is not just a technical preference, but a clinically meaningful trade-off between stroke risk, myocardial infarction risk, and long-term durability. Read the full paper to see which patients truly benefit from CEA as the default option, where CAS still has a justified role, and how 670 original studies map the evidence behind that decision.
Abstract: This paper aims to synthesize the current evidence regarding the comparative efficacy, safety, and long-term outcomes of carotid endarterectomy versus carotid artery stenting for patients with carotid stenosis, identifying key differences in periprocedural complications, long-term event rates, and specific patient considerations. The review utilises 670 original studies with 15036202 total participants (topic deduplicated ΣN). Across the mapped evidence, CAS consistently signaled higher periprocedural stroke or death than CEA, with immediate events reported as 4.7% for CAS versus 1.9% for CEA (OR 2.6) and an elevated adjusted stroke odds for CAS (aOR 1.55). In contrast, CEA more often aligned with periprocedural myocardial infarction, exemplified by lower MI risk with stenting in CREST (HR 0.50), reinforcing a recurrent stroke–MI trade-off that should drive individualized selection. Durability signals also favored CEA, as moderate (≥50%) restenosis was more frequent after CAS than CEA over 5 years (40.7% vs 29.6%; HR 1.43) and was linked to subsequent ipsilateral stroke risk. Mechanistic and surrogate-outcome literature further supported greater embolic burden with CAS (more DWI lesions/microembolic signals) and distinct hemodynamic complication profiles, underscoring the need for careful peri-procedural management and structured surveillance after stenting. Clinically, these patterns support CEA as the default revascularization option for many symptomatic patients when surgical risk is acceptable, while reserving CAS for carefully selected scenarios where surgical or cardiac risk considerations dominate and follow-up capacity is strong. Future research should focus on contemporary, subgroup-powered comparative studies (including sex- and age-stratified analyses) that clarify which technical and patient factors most reliably mitigate CAS-related early stroke risk while preserving its cardiac safety advantage.
Final search date and database lock: 2026-03-22 12:41:18 CET
Plan: Pro (expanded craft tokens; source: PubMed)
Source: PubMed
Total Abstracts/Papers: 2802
Downloaded Abstracts/Papers: 2802
Included original and non-original Abstracts/Papers (all): 852
Included original Abstracts/Papers (Vote counting by direction of effect): 670
Reference Index (links used in paper): 105
Total participants (topic deduplicated ΣN): 15036202
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