A Systematic Review and Meta-Analysis of Outcome After Repeat Revascularization for Primary Carotid Artery Restenosis.
Mert Kök, Franziska Röder, Reinoud P H Bokkers et al.
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In 30 seconds
This systematic review and meta-analysis compared carotid artery stenting (CAS) with carotid endarterectomy (CEA) for repeat revascularization of primary carotid restenosis, regardless of the initial procedure. Nineteen studies included 10,171 procedures in 10,041 patients. The overall rate of transient ischemic attack or any stroke did not differ significantly between approaches; after adjustment for symptomatic status, the odds were higher with CEA than CAS (OR 2.05, 95% CI 1.29-3.27, p < 0.01). CEA was also associated with more myocardial infarction, while most other outcomes were similar.
Key findings
- Overall, TIA or any stroke rates did not differ significantly; after adjustment for symptomatic status, odds were higher after CEA than CAS (OR: 2.05, 95% CI: 1.29-3.27, p < 0.01).
- Myocardial infarction was more frequent after CEA than CAS (OR: 1.85, 95% CI: 1.19-2.86, p < 0.01).
- Cranial nerve injury occurred only after CEA (7.56%, 95% CI: 4.21%-13.22%); other secondary outcomes showed no significant between-group differences.
- Long-term secondary restenosis risk was similar after CEA and CAS (OR: 0.98, 95% CI: 0.39-2.49, p = 0.95).
Why it matters
Repeat treatment for carotid restenosis involves balancing neurological, cardiac, and procedural risks. This synthesis suggests broadly comparable primary outcomes, while identifying higher adjusted TIA/stroke odds and more myocardial infarction with CEA, and cranial nerve injury confined to CEA. These findings help frame the trade-offs clinicians may consider when assessing revascularization options.
What to keep in mind
The authors describe the evidence as limited quality and based mostly on retrospective, nonrandomized studies, so comparisons may be affected by confounding.