CAROTID artery stenting leads to a higher risk of stroke and vessel narrowing compared to carotid endarterectomy, but offers a lower risk of heart attack and cranial nerve injury, according to a new meta-analysis of randomised controlled trials. The findings emphasise the need for careful patient selection and tailored approaches to preventing ischaemic stroke.
Carotid artery stenosis, a narrowing of the main blood vessels supplying the brain, is a significant risk factor for stroke. Two interventions are frequently used to address this: carotid artery stenting (CAS), which places a mesh tube to hold the artery open, and carotid endarterectomy (CEA), a surgical procedure to remove the blockage. As both strategies can carry risks, choosing the right approach for individual patients remains a challenge for clinicians.
Researchers systematically reviewed trials comparing the two procedures, pooling results from several medical databases. Their meta-analysis included studies that measured the risk of stroke, restenosis (re-narrowing of the artery), heart attack, cranial nerve injury and other complications. Compared to CEA, CAS was linked with a 49 percent greater risk of stroke (risk ratio 1.49) and a marginally higher risk of restenosis (risk ratio 1.26). On the other hand, CAS patients showed a 52 percent lower risk of myocardial infarction and a strikingly lower rate of cranial nerve palsy. No meaningful differences emerged for overall mortality, transient ischaemic attack or pulmonary embolism.
The results suggest that no single intervention is universally superior; treatment should be matched to each patient’s risk factors and health history. For those at high risk of cardiac complications, CAS may be preferable, while CEA may offer the best stroke protection for others. Clinicians should weigh these risks with their patients, considering individual preferences and overall health when planning interventions.
Reference
Chu G et al. Carotid Artery Stenting Versus Carotid Endarterectomy for Carotid Artery Stenosis: Systematic Review and Meta-Analysis of Randomized Controlled Trials. CCI. 2025;DOI:10.1002/ccd.70133.
