Evidence map›Paper›PMID 41860631›Full record

SynthesisJournal of neurology2026

Medical management and revascularization for asymptomatic carotid stenosis: a meta-analysis of randomized controlled trials.

Yu Gao, Lijun Wang, Hongjian Zhang, Xiaoxi Zhang, Yongxin Zhang, Chuanchuan Wang, Hongjian Shen, Pengfei Xing, Zifu Li, Yongwei Zhang and 4 more

Abstract readMeta-AnalysisReview
PubMed Publisher
In one paragraph

Synthesis in Journal of neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing 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

0 citing papers in PubMed.

No citing paper in PubMed yet.

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

14 authors.

Yu Gao *Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China.
Lijun Wang *Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China.
Hongjian Zhang *Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China.
Xiaoxi ZhangNeurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China.
Yongxin ZhangNeurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China.
Chuanchuan WangNeurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China.
Hongjian ShenNeurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China.
Pengfei XingNeurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China.
Zifu LiNeurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China.
Yongwei ZhangNeurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China.
Jens FiehlerDepartment of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Lei ZhangNeurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China. zhangleichns@163.com.
Pengfei YangNeurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China. p.yang@vip.163.com.
Jianmin LiuNeurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China. chstroke@163.com.ORCID http://orcid.org/0000-0002-3599-8267

Funding

National Natural Science Foundation of China 82371316National Natural Science Foundation of China 82571511Natural Science Basic Research Program of Shaanxi Province 25ZR1402583Noncommunicable Chronic Diseases-National Science and Technology Major Project 2024ZD0539900Opening Foundation of State Key Laboratory of Neurology and Oncology Drug Development SKLSIM-F-2024102
6 · The paper itself

Abstract

backgroundHistorical trials (ACAS/ACST) supported revascularization for asymptomatic carotid stenosis, but contemporary medical management with statins, antithrombotics, and blood pressure control may reduce stroke risk. This meta-analysis compares medical management versus revascularization (carotid endarterectomy [CEA] or stenting [CAS]) in current practice.

methodsWe searched the PubMed, Embase, Cochrane Library, and Web of Science databases to obtain articles related to "Asymptomatic Carotid Stenosis", "Medical Management" and "Revascularization" until December 5, 2025. The primary outcome was a composite of any stroke (ischemic or hemorrhagic) or death, assessed from randomization to the peri-procedural period, or ipsilateral ischemic stroke, assessed during the remaining follow-up. This study was registered in PROSPERO, CRD420251247217.

resultsThree RCTs (SPACE-2, ECST-2, CREST-2; 3,426 patients) were included. For the primary outcome, no significant difference existed between revascularization (CEA/CAS) and medical management: 4.76% (88/1,847) vs. 6.40% (101/1,579); RR 0.91 (95% CI 0.47-1.74, P = 0.77) though heterogeneity was high (I

conclusionThe present meta-analysis demonstrates that, among patients with asymptomatic carotid stenosis, the risk of stroke and mortality with contemporary medical management is comparable to that with revascularization (CEA or CAS). These findings validate current guideline recommendations, which emphasize stringent patient selection and prioritize the optimization of medical therapy prior to any revascularization procedure.

Indexed as

Carotid StenosisCerebral RevascularizationEndarterectomy, CarotidRandomized Controlled Trials as TopicStentsStrokeAsymptomatic DiseasesHumansAsymptomatic carotid stenosisCarotid endarterectomyCarotid stentingMedical managementRe-vascularization

Identifiers

PMID41860631

What Socratic holds

Textmetadata
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.