Scholarlink

Background <p>Historical 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.</p> Methods <p>We 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.</p> Results <p>Three 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, <i>P</i> = 0.77) though heterogeneity was high (I<sup>2</sup> = 74%). All-cause mortality also did not differ: 7.7% vs. 9.50%; RR 0.83 (95% CI 0.67–1.04, <i>P</i> = 0.77). Subgroup analysis showed no benefit for CEA (RR 0.73, 95% CI 0.45–1.19) or CAS (RR 0.72, 95% CI 0.23–2.27) over medical management alone.</p> Conclusion <p>The 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.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

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

  • 期刊论文

  • 发表日期：

    2026年3月20日

查看全文
  • Yu Gao,
  • Lijun Wang,
  • Hongjian Zhang,
  • Xiaoxi Zhang,
  • Yongxin Zhang,
  • Chuanchuan Wang,
  • Hongjian Shen,
  • Pengfei Xing,
  • Zifu Li,
  • Yongwei Zhang,
  • Jens Fiehler,
  • Lei Zhang,
  • Pengfei Yang,
  • Jianmin Liu

摘要

Background

Historical 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.

Methods

We 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.

Results

Three 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 (I2 = 74%). All-cause mortality also did not differ: 7.7% vs. 9.50%; RR 0.83 (95% CI 0.67–1.04, P = 0.77). Subgroup analysis showed no benefit for CEA (RR 0.73, 95% CI 0.45–1.19) or CAS (RR 0.72, 95% CI 0.23–2.27) over medical management alone.

Conclusion

The 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.