Abstract
Objective: Since its inception, there has been a disparity between the 2 procedures, Carotid Artery Stenting (CAS) and Carotid Endarterectomy (CEA) for the management of Carotid Artery Stenosis. Abundant literature comparing these 2 management modalities - including - various procedural complications, short, and long-term outcomes but, with a lot of variabilities. Our study aims to establish a firm result by comparing these studies head-to-head.
Methods: Data was extracted solely from PubMed, following the PRISMA guidelines. A systematic search ended with 26 Meta-analyses, of which 11 were included. We carried out a meta of meta-analysis using Random effect models which resulted in pooled Odds ratio with a 95% confidence interval.
Results: 4 out of the 11 studies reported Cranial Nerve Injury as an outcome. Our random effect model meta-meta-analysis depicted that there were lower odds of cranial nerve injury with CAS compared to CEA (pooled OR:0.05; 95%CI:0.03-0.08; p<0.00001) with no heterogeneity (p=0.83; I2= 0%). Moreover, out of the 11 studies under consideration, 4 reported Minor Stroke as a complication of these management modalities. There was a higher risk of minor stroke occurrence in the CAS population compared to CEA (pooled OR:2.23; 95%CI:1.80-2.76; p<0.00001) with no heterogeneity (p=1.00; I2= 0%).
Conclusion: There is a significantly reduced risk of Cranial Nerve Palsy with Carotid Artery Stenting as compared to Carotid Endarterectomy. On the contrary, there is a significantly higher risk of having a minor stroke with CAS compared to CEA. Furthermore, these outcomes open up possibilities for further prospective trials, keeping in mind the procedural complications and an ample follow-up period which would aid in exploring the realms of improved patient care.
