Comparative outcomes of elective carotid artery stenting versus optimal medical treatment in Egyptian patients with symptomatic moderate carotid artery stenosis: a case–control study

Abstract Background Carotid artery (CA) stenosis intentionally increases ischemic stroke risk, particularly in symptomatic cases. CA stenting (CAS) has emerged as a minimally invasive procedure, offering potential advantages in high-surgical-risk populations. Purpose of the study: To compare CAS with the best medical treatment (BMT) for moderate degree symptomatic CA stenosis in terms of safety and efficacy in a sample of Egyptian patients. Methods This case–control cross-sectional study was carried out on 40 patients who required angiographic confirmation of 50–69% symptomatic carotid stenosis, a recent ischemic event [Transient ischemic attack (TIA)/stroke within 1–2 months], and the presence of ≥ 1 atherosclerotic risk factor (hypertension, diabetes mellitus, hyperlipidemia, or smoking). Patients were divided into two groups: Group I: subjected to CAS, and Group II (control group): subjected to BMT. Computed tomography (CT) and Magnetic resonance imaging (MRI) brain scans, along with duplex ultrasound (US) and CT angiography (CTA), were performed for diagnosis and follow-up. Results Group I LDL was significantly higher (166.9 mg/dl) vs. Group II (126.85 mg/dl) (p = 0.001). Both groups improved neurologically; Group II showed superior outcomes with 40% achieving MRS grade 0 and significant NIHSS improvement from 6.65 ± 3.05 to 3.15 ± 2.87 (p < 0.001). CAS reduced stenosis from 59.45 ± 6.59% to 18 ± 6.35% (p < 0.001). Complication rates were comparable. Conclusions CAS is as effective and safe as BMT for moderate symptomatic CA stenosis. CAS improved vascular outcomes and neurological function. Individualized treatment decisions are essential for optimizing patient outcomes.