Comparative Evaluation of Endovascular and Surgical Therapies for Carotid Artery Disease Management

Abstract The management of carotid artery disease (CAD) can be either endovascular [carotid artery stenting, or carotid artery stenting (CAS)], or surgical (carotid endarterectomy, or CEA) therapy. This article is a narrative systematic analysis of research that compares the long-term results, safety, and effectiveness of these two modalities. A comprehensive search was carried out (from the beginning until July 2024), in PubMed, the Cochrane Library, and Embase using keywords like “CAD,” “endovascular therapy,” “surgical management,” and “stroke prevention.” Randomized controlled trials, meta-analyses, and systematic reviews comparing CAS with CEA in patients with and without symptoms were among the research works that qualified. Non-English papers, case series, and studies without comparison data were excluded. After 1250 records were separately evaluated by two reviewers, 30 high-quality studies – including seminal trials like CREST, CACS, and EVA-3S – were selected. Data on long-term mortality, restenosis rates, and perioperative complications (such as stroke, death, and cranial nerve damage) were retrieved. The findings show that although CEA exhibits better long-term patency but a greater risk of procedural stroke in some groups, CAS provides a reduced risk of cranial nerve damage but a larger chance of restenosis. The choice of treatment is influenced by both patient-specific characteristics (such as age, anatomy, and comorbidities) and technology developments (such as embolic protection devices). This study identifies areas that need more research and summarizes the evidence to support personalized decision-making.