Carotid Endarterectomy Versus Trans-Carotid Artery Revascularisation (TCAR) for Asymptomatic Carotid Stenosis A Systematic Review and Meta-Analysis.

OBJECTIVES: The treatment for asymptomatic carotid artery stenosis includes a surgical or interventional approach in selected cases. Although endarterectomy should be considered over stenting for selected patients, according to the latest European Society of Vascular Surgery (ESVS) guidelines, the Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trials (CREST-2) suggested that carotid stenting would be associated with low rates of perioperative stroke or death. The transcarotid artery revascularization (TCAR) technique is a relatively new endovascular method, which involves placing a stent at the carotid bifurcation through direct carotid artery access, performed under a flow reversal system. This approach avoids manipulation of the aortic arch, potentially reducing embolic events. The aim of this systematic review is to compare TCAR with carotid endarterectomy (CEA) in asymptomatic patients undergoing carotid intervention. It seeks to evaluate whether TCAR is associated with improved perioperative outcomes, such as lower rates of stroke and death, compared with CEA, given its potentially less invasive approach. METHODS: The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) on the platforms PubMed/Medline, OVID/Embase, and Scopus. The following MeSH terms were used: "asymptomatic carotid stenosis" AND "carotid endarterectomy", "transcarotid artery revascularization" OR "TCAR". Full-text screening and data extraction were performed with the support of the COVIDENCE platform. Six studies were selected for this systematic review, comprising a total of 132,684 patients (30,581 undergoing TCAR and 102,103 undergoing CEA). Statistical analysis was performed using R software. RESULTS: The selected studies for this systematic review showed similar results in terms of perioperative stroke and death for asymptomatic patients who underwent carotid endarterectomy and TCAR. CONCLUSION: Our results suggest that there are no significant differences between CEA and TCAR for the treatment of asymptomatic patients who require a surgical or interventional approach. Further studies are necessary to provide more robust data in this field.