The University of Toledo Translation Journal of Medical Sciences 
Internal Medicine Abstract, Department of Medicine Research Symposium UTJMS 2023 May 5; 11(1):e1-e1 

Efficacy and Safety of Carotid 
Endarterectomy Versus Carotid Artery 
Stenting in Asymptomatic Severe Carotid 
Stenosis: A Systematic Review and Meta-
Analysis 
N. Patel, MD1*, M. Patel1, MD, C. Burmeister, MD1, S. Bhuta, MD1, A. Elzanaty,
MD2, E. Eltahawy3, MD

1Division of Internal Medicine, Department of Medicine, The University of Toledo, 
Toledo, OH 43614 
2Department of Urology, The University of Toledo, Toledo, OH 43614 
3Division of Cardiovascular Medicine, Department of Medicine, The University of 
Toledo, Toledo, OH 43614 

*Corresponding author: neha.patel@utoledo.edu

Published: 05 May 2023 

Background: Severe carotid stenosis (CS) is defined as 70-99% blockage of the carotid artery. In 
patients with severe CS, both carotid endarterectomy (CEA) and carotid artery stenting (CAS) carry 
procedural risks, however they can restore patency and significantly reduce long-term stroke risk. Most 
studies compare outcomes between procedures in symptomatic patients; however, there is limited data 
comparing CEA to CAS in asymptomatic severe CS.   

Methods: We performed a literature search using PubMed, Embase, and Cochrane Library from 
inception through September 2021 to investigate the efficacy and safety of CAS compared to CEA in 
patients with asymptomatic severe CS. The primary outcome was all-cause mortality and secondary 
outcomes were stroke, MI, and stroke post 30-day follow up.    

Results: 4 randomized controlled trials involving 6442 patients were included in this meta-analysis. 
There is no difference in the primary outcome of all-cause mortality between CEA and CAS. Compared 
to CAS, CEA has significantly lower rate of stroke [RR 1.56; CI 1.13, 2.15; P = 0.006]. Alternatively, 
CAS has significantly lower rate of MI [RR 0.49; CI 0.27, 0.91; P = 0.02]. There is no significant 
difference in risk of stroke post 30-day follow up.   

Conclusion: Based on our results, there is lower risk of stroke with CEA and lower risk of MI with 
CAS, however no difference in all-cause mortality or stroke post 30-day follow-up. Further trials with 
large sample sizes are needed to confirm our findings. 

https://dx.doi.org/10.46570/utjms.vol11-2023-711 

https://dx.doi.org/10.46570/utjms.vol11-2023-711
mailto:neha.patel@utoledo.edu