This systematic review and network meta-analysis examined fifty-five studies involving patients with carotid artery stenosis. The researchers compared three main treatments: carotid endarterectomy (CEA), carotid artery stenting (CAS), and trans-carotid artery revascularization (TCAR). The goal was to see which options offered the best balance of safety and effectiveness for preventing stroke and other complications.
The analysis found that CEA was associated with a significantly lower risk of short-term stroke compared to CAS. However, patients undergoing CAS faced lower risks of cranial nerve injury, hematoma, and infection compared to those having CEA. There were no significant differences observed between the treatments regarding short-term mortality or the risk of myocardial infarction. The review also noted a potential long-term mortality benefit for TCAR over CAS, though this finding requires further validation.
Experts caution that the current evidence on the safety and efficacy of these interventions is limited. The authors state that further high-quality randomized controlled trials, particularly focusing on TCAR, are needed to confirm these comparative outcomes. When choosing a treatment, doctors and patients should carefully consider both the efficacy and safety profiles of each option.