ABSTRACT
The meta-analysis highlighted significant heterogeneity between the results of the randomized studies. This difference is likely to be the result of the endovascular technique used (stenting vs. balloon angioplasty, and use of cerebral protection or not), patient characteristics (symptomatic vs. asymptomatic, and normal vs. high surgical risk), and status of trial (completed vs. stopped prematurely). The reviewers concluded that carotid angioplasty and stenting had similar major risks and benefits compared with surgery and avoid minor morbidity. This conclusion should be interpreted with caution as two trials were stopped because of concerns over stenting. Furthermore, there remains uncertainty about the potential for restenosis following endovascular treatment to cause recurrent stroke. Moreover, despite analyzing data from over 1100 patients in the meta-analysis, the confidence intervals surrounding the odds ratios for the comparison between events after endovascular treatment and surgery remain wide. Hence, it remains possible that one treatment may be substantially more hazardous or less effective than the other. This meta-analysis will be regularly updated to take into account new data (46).
