Evidence map›Paper›PMID 40854696›Full record

SynthesisJournal of neurointerventional surgery2026

Comparative safety and efficacy of invasive therapies for carotid artery stenosis: a systematic review and network meta-analysis.

Muhammad Yunus Amran, Yusran Ady Fitrah, Nabilah Puteri Larassaphira, Andi Muh Aunul Khaliq Gunawan, Andi Muhammad Hanif Abdillah, Aulia Rezky Mufidah Toaha, Ahmad Taufik Fadillah Zainal, Siti Giranti Ardilia Gunadi

Abstract readSystematic ReviewMeta-AnalysisComparative Study
In one paragraph

Synthesis in Journal of neurointerventional surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Muhammad Yunus AmranDivision of Interventional Neurology and Neuroendovascular Therapy, Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia muhyunusamran@med.unhas.ac.id.ORCID http://orcid.org/0000-0001-5079-7490
Yusran Ady FitrahDepartment of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.ORCID http://orcid.org/0009-0001-2284-199X
Nabilah Puteri LarassaphiraDepartment of Medical Profession, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.ORCID http://orcid.org/0009-0002-9193-2382
Andi Muh Aunul Khaliq GunawanDepartment of Medical Profession, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.ORCID http://orcid.org/0000-0002-7403-6351
Andi Muhammad Hanif AbdillahDepartment of Medical Profession, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.ORCID http://orcid.org/0009-0001-2637-1980
Aulia Rezky Mufidah ToahaDepartment of Medical Profession, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.ORCID http://orcid.org/0009-0004-9254-7034
Ahmad Taufik Fadillah ZainalDivision of Urology, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.ORCID http://orcid.org/0000-0002-3480-7692
Siti Giranti Ardilia GunadiDepartment of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.ORCID http://orcid.org/0009-0001-0215-5319

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCarotid artery stenosis is a major cause of stroke and is commonly treated with carotid endarterectomy (CEA) or carotid artery stenting (CAS). Trans-carotid artery revascularization (TCAR) has emerged as a newer alternative designed to reduce the risk of procedural stroke. However, comparative evidence on the safety and efficacy of these interventions is limited. This study evaluates the clinical outcomes of CEA, CAS, and TCAR in patients with carotid artery stenosis.

methodsA comprehensive search of multiple databases was conducted to identify relevant studies. The outcomes were stroke, mortality, and myocardial infarction, cranial nerve injury, hematoma, infection, transient ischemic attack, and length of hospital stay. Meta-analysis and a frequentist graph-theoretical approach network meta-analysis were performed using the netmeta package in R platform. Risk of bias was assessed using RoB 2 Cochrane and ROBINS-I.

resultsFifty-five studies were included in the review. The short-term stroke risk was significantly lower with CEA than with CAS. TCAR had a potential long-term mortality benefit over CAS, while no significant differences were observed in short-term mortality or myocardial infarction across treatments. CAS was associated with lower risks of cranial nerve injury, hematoma, and infection compared with CEA.

conclusionCEA and TCAR offer better short-term stroke protection than CAS, with TCAR showing promise for long-term mortality benefits. CAS has advantages in reducing cranial nerve injury, hematoma, and infection risks. Overall, the choice of treatment should consider both efficacy and safety profiles. Further high-quality randomized controlled trials, particularly focusing on TCAR, are needed to validate these comparative outcomes. PROSPERO REGISTRY NUMBER: CRD420251055287.

Indexed as

Carotid StenosisEndarterectomy, CarotidStentsHumansNetwork Meta-Analysis as TopicStrokeTreatment OutcomeAngioplastyStenosisStentStroke

Identifiers

PMID40854696
PMCPMC13217107

What Socratic holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.