Adverse outcomes following carotid artery stenting in echolucent plaques: a systematic review and meta-analysis

Abstract

Abstract Objective Conflicting evidence exists regarding carotid artery stenting (CAS) interventions on echolucent plaques and adverse outcomes. This meta-analysis aims to assess the relationship between carotid plaque echogenicity and adverse outcomes following CAS. Methods We conducted a systematic search of electronic databases (PubMed, MEDLINE, EMBASE and Cochrane Center Register) up to January 2024. Two researchers independently assessed the eligibility of studies that used ultrasound to assess carotid artery plaque echogenicity and its relationship with adverse outcomes after CAS. We used web-based systematic review production software RevMan to conduct the analysis. Results Eight studies including 810 patients’ data that have reported on in-stent restenosis, distal embolization and stroke after CAS were meta-analyzed. Mean age of the participants was 68±11 years and 43% were females. CAS performed on echolucent plaques demonstrated a higher frequency of association with distal microembolization OR=3.64 (95% CI 2.11-6.30, p<0.001), in-stent restenosis OR=2.87 (95% CI 1.84-4.47, p=0.003) and stroke OR=3.80 (95% CI 1.93-7.44, p<0.001). In the pooled analysis covering all adverse outcomes following CAS, the OR was 3.28 (95% CI 2.41-4.45, p<0.001, I2=25%). Conclusions Arterial stenting performed on echolucent carotid plaques was more frequently associated with adverse outcomes, such as stroke, distal microembolization, and in-stent restenosis.