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Medical treatment versus endarterectomy for symptomatic carotid stenosis: systematic review and meta-analysis

José R Rodrigues1, Andreia Coelho2,3, Armando Mansilha2,4

  • 1Faculty of Medicine, University of Porto, Porto, Portugal - jrodrigorodrigues@outllook.pt.

International Angiology : a Journal of the International Union of Angiology
|April 2, 2025
PubMed

Insights

Best medical treatment for symptomatic carotid stenosis may show a trend toward higher stroke and death risks compared to revascularization. More long-term data is needed to fully assess the risk-benefit of medical versus invasive approaches.

Area of Science:

  • Cardiovascular Medicine
  • Neurology
  • Interventional Cardiology

Background:

  • Symptomatic carotid stenosis treatment traditionally involves revascularization.
  • Advances in medical treatment offer an alternative for low-risk patients.
  • Limited long-term outcome data exists for medically treated patients, necessitating risk-benefit reassessment.

Purpose of the Study:

  • To review evidence on long-term outcomes for symptomatic carotid stenosis patients managed with best medical treatment alone.
  • To evaluate if additional revascularization provides benefits over best medical treatment.

Main Methods:

  • A systematic review was conducted.
  • Methodology adhered to Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) guidelines.

Main Results:

  • The medical group showed a trend towards higher risks: stroke (6.96%), death (3.14%), and combined stroke or death (8.91%).
  • Revascularization group risks were lower: stroke (4.51%), death (2.65%), and combined stroke or death (6.56%).

Conclusions:

  • Despite advancements, long-term outcomes data for best medical treatment in symptomatic carotid stenosis is scarce.
  • Future research should include medical treatment arms to accurately assess long-term event incidence.
Abstract

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