The Role of Carotid Graft Interposition During Elective and Emergent Interventions: Protocol for a Scoping Review.

Abstract

Background: In a significant proportion of carotid interventions, carotid graft replacement is required to achieve a successful outcome either as a primary method or as a bailout solution. Whether carotid grafting should be performed, the indications for its use, and other technical aspects remain insufficiently addressed in the literature. An exhaustive mapping of the sparse and heterogeneous evidence available in the literature may provide a more comprehensive understanding of this topic.

Objective: This scoping review aims to examine and summarize the scientific evidence on the indications, graft types, and outcomes of graft interposition during elective and emergency carotid interventions.

Methods: This scoping review will be conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines for reporting. Peer-reviewed papers written in English will be identified through searches of the following databases: PubMed (MEDLINE), Embase, Scopus, and Web of Science. The web-based systematic review platform Rayyan will be used for deduplication and study screening. The review will encompass the following clinical scenarios: elective carotid endarterectomy, emergent carotid endarterectomy, carotid artery restenosis, carotid artery trauma, carotid artery aneurysm, carotid artery dissection, carotid patch infection, radiation-induced carotid fibrosis, and carotid body tumors. All study designs (randomized controlled trials, observational studies, and case series) will be considered. Non-English studies, animal studies, cadaveric or anatomical-only reports, and purely technical notes without clinical data will be excluded. Data regarding extracranial-to-intracranial bypass will be excluded. Study selection based on title and abstract screening (first stage), full-text review (second stage), and data extraction (third stage) will be performed by a group of researchers, whereby each paper will be reviewed by at least 2 researchers. Any conflict regarding the inclusion or exclusion of a study and the data extraction will be resolved by discussion between the researchers who evaluated the papers; a third researcher will be involved if consensus is not reached. Data synthesis will be performed with the aim of clearly presenting the indications, graft types, and outcomes of graft interposition during carotid interventions.

Results: The search strategy was finalized in July 2026. Preliminary searches of PubMed (MEDLINE), PROSPERO, and JBI Evidence Synthesis databases identified no published or registered systematic or scoping reviews specifically addressing carotid interposition grafting across elective and emergent carotid interventions. As of September 2026, formal database searches and study selection had not yet begun and were scheduled to start in October 2026. Data extraction and evidence synthesis are expected to be completed by spring 2027, and submission of the final scoping review is planned for summer 2027.

Conclusions: Our scoping review will seek to provide an overview of the available evidence and identify research gaps regarding the role of graft interposition during elective and emergent carotid interventions.