Seven RCTs (n=2,973) were included in the review. Sample size ranged from 85 to 1,200.
Endovascular treatment was associated with a higher risk of any stroke or death with 30 days compared to surgery (8.2% versus 6.2%, OR 1.35, 95% CI 1.01 to 1.79, p=0.04; seven RCTs). There was no statistically significant difference between the groups in the risk of disabling stroke or death. There were also no significant differences in the risk of any stroke or death within one year. Moderate heterogeneity was found for all of these analyses.
There were significantly lower risks of cranial nerve palsy (0.2% versus 4.7%, OR 0.17, 95% CI 0.11 to 0.27, p<0.0001; six RCTs) and myocardial infarction (0.9% versus 2.3%, OR 0.37, 95% CI 0.16 to 0.89, p=0.027; five RCTs) in the endovascular treatment than in the surgery groups. There was no evidence of statistically significant heterogeneity for either analysis.