Influence of Diabetes Mellitus on Outcomes of Patients Undergoing Carotid Artery Stenting: A Systematic Review and Meta-Analysis

Diabetes mellitus is a well-known risk factor for adverse vascular events, yet its specific influence on carotid artery stenting (CAS) outcomes remains unclear. This study aims to determine if diabetes increases perioperative risks after CAS.

A systematic review and meta-analysis compared diabetic versus nondiabetic CAS patients. We searched PubMed, Embase, Scopus, and Cochrane Library for English cohort studies reporting outcomes by diabetic status. Primary outcome was perioperative stroke; secondary included transient ischemic attack (TIA), myocardial infarction (MI), death, restenosis, and stroke/death composite. Data were pooled using random-effects models. Heterogeneity was quantified by I², and publication bias was assessed with Egger regression.

Twelve cohort studies (22,226 patients; 7,415 diabetic) were included. Meta-analysis found diabetes was not significantly associated with increased risk of perioperative stroke (risk ratio [RR] 1.16; 95% confidence interval [CI] 0.79-1.69), TIA (RR 1.42; 95% CI 0.98-2.06), MI (RR 1.60; 95% CI 0.87-2.94), all-cause mortality (RR 0.90; 95% CI 0.61-1.32), and stroke/death composite (RR 1.07; 95% CI 0.79-1.45). However, diabetes significantly increased long-term target-vessel restenosis risk (RR 2.10; 95% CI 1.18-3.73; I² = 37%). Heterogeneity was low (I² 0%-37%). Sensitivity analyses confirmed stability. Funnel plots were symmetric; the Egger test was nonsignificant (P = 0.383).

In carefully selected patients, diabetes does not elevate the short-term risks of stroke, TIA, MI, or death following CAS. However, it is associated with a significantly higher long-term risk of restenosis. These results support the safe use of CAS in diabetic patients but underscore the need for enhanced long-term surveillance to manage restenosis risk.