Medical management and revascularization for asymptomatic carotid stenosis: a meta-analysis of randomized controlled trials - PubMed
5 hours ago
- #medical-management
- #revascularization
- #asymptomatic-carotid-stenosis
- Historical trials (ACAS/ACST) supported revascularization for asymptomatic carotid stenosis, but contemporary medical management may reduce stroke risk.
- This meta-analysis compares medical management versus revascularization (CEA or CAS) in current practice.
- Three RCTs (SPACE-2, ECST-2, CREST-2; 3,426 patients) were included.
- No significant difference in primary outcome (stroke or death) between revascularization and medical management: 4.76% vs. 6.40%.
- All-cause mortality also did not differ: 7.7% vs. 9.50%.
- Subgroup analysis showed no benefit for CEA or CAS over medical management alone.
- Contemporary medical management has comparable stroke and mortality risk to revascularization for asymptomatic carotid stenosis.
- Findings validate current guideline recommendations emphasizing stringent patient selection and optimization of medical therapy.