Efficacy and safety of carotid endarterectomy, carotid stenting and optimal drug therapy for stenotic lesion combined with tortuosity of internal carotid artery: a systematic review and network meta-analysis

Abstract

The main factors of ischemic stroke are pathological changes in internal carotid arteries, such as stenosis due to atherosclerotic process and/or tortuosity. The purpose of this review was to compare efficacy and safety of «protected» internal carotid artery stenting, carotid endarterectomy with reconstructive component and optimal drug therapy for combination of internal carotid artery stenosis and tortuosity in adults. This systematic review and meta-analysis are based on the PRISMA recommendations. Endovascular methods did not show comparable efficacy and safety with open surgery, but also allowed inferiority of carotid artery stenting techniques as evidenced by wide confidence interval. Patients after surgical treatment have a lower risk of acute cerebrovascular accident compared to conservative treatment. High quality meta-analysis requires randomized or large cohort clinical trials comparing results of surgery, endovascular treatment and optimal drug therapy for combination of stenosis and tortuosity of internal carotid arteries.