Global trends in the management of carotid artery stenosis: A bibliometric analysis from 2012 to 2022

Abstract: INTRODUCTION: Carotid stenosis causes about 10%–20% of ischemic stroke cases. Landmark clinical trials revealed the utility of endarterectomy for symptomatic patients with > 50% stenosis or asymptomatic patients with > 70% stenosis. Then, trials on stenting exhibited alternative, safer approach in patients younger than 70 years old, and at higher risk of myocardial infarction. Our bibliometrics study explores how carotid stenosis literature has changed between 2012 and 2022 to reflect novel treatment options and research. METHODS: The Web of Science database was investigated for 6,639 publication items between 2012 and 2022 pertaining to carotid stenosis in neurosurgery. Networks were built to analyze keywords, key terms, countries of publication, and popular journals for submission. Subsequently, items within each network were organized into clusters and evaluated for publication date. Items were ranked for their interconnectedness to other items and prevalence within the literature. The most relevant items were tracked over time. In addition, relevant terms and connections were isolated from the network. RESULTS: Terms were arranged into six major clusters (treatments, imaging, risk factors, prognostic markers, plaque characteristics, and basic science research). The treatment and basic science clusters contained terms with more recent popularity. The phrase “carotid endarterectomy” was more prevalent than “carotid stenosis” across all years except 2018. In addition, the term “mouse” in the basic science cluster was connected to all other clusters revealing the increased translational research. The United States was the largest publisher overall and China published the most recent articles. CONCLUSIONS: Modern research on carotid stenosis is characterized by advancements in basic science and preference for carotid endarterectomy. Past reports suggest that endarterectomy provides better outcomes than stenting. As treatment options continue to expand into modern scientific enterprise, developing nations will continue to impact the future of carotid stenosis research and top-tier journals will remain the largest outlet of such research.