The authors reported including seven RCTs (n=1,480 carotid endarterectomy patients and n=1,492 carotid angioplasty with stent placement patients) in the review; the results of eight trials are included in the analyses. Blinding was not possible due the nature of the intervention and study design. Of the eight trials included in the analyses, all but one scored 3 points on the Jadad scale; the remaining trial scored 1 point. Sample sizes ranged from 17 to 1183; three trials recruited fewer than 105 patients.
A significant benefit for carotid endarterectomy over carotid angioplasty with stent placement was reported for death or any stroke at 30 days post-procedure (OR 1.39, 95% CI: 1.05 to 1.84; eight trials; I2=59.4%); the risk of death, any stoke, or myocardial infarction at 30 days (effect size not reported); ipsilateral ischaemic stroke at 30 days (OR 1.48, 95% CI: 1.05 to 2.07); any stroke at 30 days (OR 1.50, 95% CI: 1.05 to 2.16); death or stroke at six months follow-up (OR 1.99, 95% CI: 1.09 to 3.62); and the risk of procedural failure (OR 3.42, 95% CI: 2.03 to 5.79). I2, χ2 and number of included trials were not reported for many of the outcomes.
The risk of cranial neuropathy at 30 days (OR 1.99, 95% CI: 1.09 to 3.62; six trials) was significantly reduced for carotid angioplasty with stent placement in comparison with carotid endarterectomy.
No significant differences between the two procedures were reported for the odds of death or disabling stroke at 30 days (six trials), death or stroke at one year follow-up (four trials) and ipsilateral intracerebral bleeding at 30 days.
The results of further analyses were also reported in the review, but in the majority of cases did not significantly change the original findings.
Funnel plots showed no evidence of publication bias.