Revascularization Plus Medical Therapy Versus Medical Therapy Alone for Asymptomatic Carotid Stenosis: A Meta-Analysis

IF 2.5 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging Pub Date : 2026-09-28 DOI:10.1111/jon.70148

Mohammed M. Al-Salihi, Maryam S. Al-Jebur, Adam Rizvi, Ahmed Saleh, Ufuk Erginoglu, Farhan Siddiq, Ali Ayyad, Mustafa K. Baskaya, Adnan I. Qureshi

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引用次数: 0

Abstract

Background

Management of asymptomatic carotid stenosis (ACS) remains controversial, particularly as contemporary optimal medical therapy (OMT) has evolved beyond the aspirin-based regimens used in earlier trials. We performed a meta-analysis comparing carotid revascularization plus OMT versus OMT alone in patients with ACS.

Methods

We searched five databases (PubMed, Embase, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials [CENTRAL]) from inception to November 2025. Randomized controlled trials comparing carotid revascularization (endarterectomy or stenting) plus OMT versus OMT alone were included. Primary outcomes were 30- to 44-day mortality and stroke. Other outcomes included long-term all-cause mortality, stroke, myocardial infarction, and intracerebral hemorrhage. All statistical analyses were performed in R, and risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using either fixed- or random-effects models.

Results

Six trials involving 8276 patients were included. Revascularization significantly increased 30- to 44-day mortality (RR 3.98 [95% CI, 1.53–10.35], p = 0.0046) and stroke risk (RR 4.53 [95% CI, 2.51–8.17], p < 0.0001). However, long-term follow-up demonstrated significant reductions in all-cause mortality (RR 0.80 [95% CI, 0.68–0.93], p = 0.0053) and stroke (RR 0.66 [95% CI, 0.57–0.76], p < 0.0001). No significant differences were observed in myocardial infarction or intracerebral hemorrhage rates.

Conclusions

Carotid revascularization combined with OMT was associated with increased periprocedural risks but lower long-term stroke and mortality in pooled analyses of patients with ACS. These findings should be interpreted cautiously given differences across trials and evolving OMT standards. Patient selection should balance procedural risks against potential long-term benefit, particularly among patients with high-grade stenosis, low periprocedural risk, and access to experienced centers.

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血管重建术加药物治疗与单纯药物治疗治疗无症状颈动脉狭窄的meta分析

背景：无症状颈动脉狭窄（ACS）的治疗仍然存在争议，特别是当代最佳药物治疗（OMT）已经超越了早期试验中使用的以阿司匹林为基础的方案。我们进行了一项荟萃分析，比较ACS患者颈动脉血运重建术加OMT与单独OMT。方法：我们检索了5个数据库（PubMed、Embase、Web of Science、Scopus和Cochrane Central Register of Controlled Trials [Central]），检索时间从成立到2025年11月。随机对照试验比较了颈动脉血运重建术（动脉内膜切除术或支架置入术）加OMT和单独OMT。主要结局是30- 44天死亡率和中风。其他结果包括长期全因死亡率、中风、心肌梗死和脑出血。所有统计分析均以R进行，95%置信区间（ci）的风险比（RRs）使用固定效应或随机效应模型进行汇总。结果：纳入6项试验，共8276例患者。血管重建术显著增加了ACS患者30- 44天的死亡率（RR 3.98 [95% CI, 1.53-10.35], p = 0.0046）和卒中风险（RR 4.53 [95% CI, 2.51-8.17], p）。结论：在ACS患者的汇总分析中，颈动脉血管重建术联合OMT与围手术期风险增加相关，但降低了长期卒中和死亡率。考虑到不同试验和不断发展的OMT标准的差异，这些发现应谨慎解释。患者的选择应平衡手术风险和潜在的长期获益，特别是在高度狭窄、低围手术期风险和可进入经验丰富的中心的患者中。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Neuroimaging 医学-核医学

CiteScore

4.70

自引率

0.00%

发文量

117

审稿时长

6-12 weeks

期刊介绍： Start reading the Journal of Neuroimaging to learn the latest neurological imaging techniques. The peer-reviewed research is written in a practical clinical context, giving you the information you need on: MRI CT Carotid Ultrasound and TCD SPECT PET Endovascular Surgical Neuroradiology Functional MRI Xenon CT and other new and upcoming neuroscientific modalities.The Journal of Neuroimaging addresses the full spectrum of human nervous system disease, including stroke, neoplasia, degenerating and demyelinating disease, epilepsy, tumors, lesions, infectious disease, cerebral vascular arterial diseases, toxic-metabolic disease, psychoses, dementias, heredo-familial disease, and trauma.Offering original research, review articles, case reports, neuroimaging CPCs, and evaluations of instruments and technology relevant to the nervous system, the Journal of Neuroimaging focuses on useful clinical developments and applications, tested techniques and interpretations, patient care, diagnostics, and therapeutics. Start reading today!