Korean Circ J.  2020 Apr;50(4):330-342. 10.4070/kcj.2019.0125.

Role of Carotid Artery Stenting in Prevention of Stroke for Asymptomatic Carotid Stenosis: Bayesian Cross-Design and Network Meta-Analyses

  • 1Department of Cardiology in Internal Medicine, School of Medicine, Chungnam National University, Chungnam National University Hospital, Daejeon, Korea. myheart@cnu.ac.kr
  • 2Department of Cardiology, Daegu Fatima Hospital, Daegu, Korea.
  • 3Department of Statistics, Kyungpook National University, Daegu, Korea.
  • 4Division of Cardiology, Department of Internal Medicine, Korea University Medical Center Anam Hospital, Seoul, Korea.


There is insufficient evidence regarding the optimal treatment for asymptomatic carotid stenosis.
Bayesian cross-design and network meta-analyses were performed to compare the safety and efficacy among carotid artery stenting (CAS), carotid endarterectomy (CEA), and medical treatment (MT). We identified 18 studies (4 randomized controlled trials [RCTs] and 14 nonrandomized, comparative studies [NRCSs]) comparing CAS with CEA, and 4 RCTs comparing CEA with MT from MEDLINE, Cochrane Library, and Embase databases.
The risk for periprocedural stroke tended to increase in CAS, compared to CEA (odds ratio [OR], 1.86; 95% credible interval [CrI], 0.62-4.54). However, estimates for periprocedural myocardial infarction (MI) were quite heterogeneous in RCTs and NRCSs. Despite a trend of decreased risk with CAS in RCTs (OR, 0.70; 95% CrI, 0.27-1.24), the risk was similar in NRCSs (OR, 1.02; 95% CrI, 0.87-1.18). In indirect comparisons of MT and CAS, MT showed a tendency to have a higher risk for the composite of periprocedural death, stroke, MI, or nonperiprocedural ipsilateral stroke (OR, 1.30; 95% CrI, 0.74-2.73). Analyses of study characteristics showed that CEA-versus-MT studies took place about 10-year earlier than CEA-versus-CAS studies.
A similar risk for periprocedural MI between CEA and CAS in NRCSs suggested that concerns about periprocedural MI accompanied by CEA might not matter in real-world practice when preoperative evaluation and management are working. Maybe the benefits of CAS over MT have been overestimated considering advances in medical therapy within10-year gap between CEA-versus-MT and CEA-versus-CAS studies.


Carotid artery stenosis; Carotid endarterectomy

MeSH Terms

Carotid Arteries*
Carotid Stenosis*
Endarterectomy, Carotid
Myocardial Infarction
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