{
  "abstract": "Background Carotid 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.Methods A 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.Results Fifty-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.Conclusion CEA 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.",
  "authors": [
    {
      "affiliations": [
        "Division of Interventional Neurology and Neuroendovascular Therapy, Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia",
        "Brain Centre, RSUP Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia",
        "Hasanuddin University Teaching Hospital, Makassar, Indonesia"
      ],
      "name": "Muhammad Yunus Amran"
    },
    {
      "affiliations": [
        "Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia"
      ],
      "name": "Yusran Ady Fitrah"
    },
    {
      "affiliations": [
        "Department of Medical Profession, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia"
      ],
      "name": "Nabilah Puteri Larassaphira"
    },
    {
      "affiliations": [
        "Department of Medical Profession, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia"
      ],
      "name": "Andi Muh Aunul Khaliq Gunawan"
    },
    {
      "affiliations": [
        "Department of Medical Profession, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia"
      ],
      "name": "Andi Muhammad Hanif Abdillah"
    },
    {
      "affiliations": [
        "Department of Medical Profession, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia"
      ],
      "name": "Aulia Rezky Mufidah Toaha"
    },
    {
      "affiliations": [
        "Division of Urology, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia"
      ],
      "name": "Ahmad Taufik Fadillah Zainal"
    },
    {
      "affiliations": [
        "Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia"
      ],
      "name": "Siti Giranti Ardilia Gunadi"
    }
  ],
  "title": "Comparative safety and efficacy of invasive therapies for carotid artery stenosis: a systematic review and network meta-analysis",
  "uid": "ac34694a-cc50-5cf4-9afe-11cc9de4395e"
}