Carotid Endarterectomy Versus Carotid Artery Stenting With Double-Layer Micromesh Stent in Carotid Angioplasty: Network Meta-Analysis
Bibliographic record
Abstract
Introduction: Carotid endarterectomy (CEA) remains the gold standard for carotid stenosis, but modern carotid artery stenting (CAS) with double-layer micromesh stents (e.g., CGuard, Roadsaver [RS]) offers potential reductions in peri-procedural embolic risk. However, comparative evidence between CEA and modern CAS remains limited. Methods: A systematic search of PubMed, ScienceDirect, and Europe PMC (June 23,2025) identified randomized and observational studies on symptomatic or high grade asymptomatic carotid stenosis using terms including “double-layer stent,” “micromesh,” “Roadsaver,” “CGuard,” and “carotid endarterectomy.” Reviews, meta analyses, and case reports were excluded. Comparisons included single-layer CAS vs. CEA, single-layer CAS vs. CGuard/RS, and indirect CEA vs. CGuard/RS. Outcomes were neurological complications and neurological death. Study quality was assessed using Cochrane RoB 2.0 and Newcastle-Ottawa Scale (NOS). A frequentist random effects network meta-analysis was performed using MetaInsight. Results: Eleven studies (7 RCTs, 4 observational; n=9483) were included. Seven had moderate RoB 2.0 risk, while three observational studies had fair quality and one study had good quality according to NOS. No significant difference was detected in neurological complications between CEA and CGuard/RS (OR 0.79; 95% CI 0.34-1.80), and neurological death was similar among CEA, CGuard/RS, and CAS. When compared with conventional CAS, CEA (OR 0.90; 95% CI 0.69–1.18) and CGuard/RS (OR 1.04; 95% CI 0.30–3.65) showed no significant differences. The direct comparison between CEA and CGuard/RS also demonstrated no significant effect (OR 0.86; 95% CI 0.24–3.11).Conclusions: This study found no significant differences in stroke prevention or safety CEA and DLMS. Larger comparative studies are required to establish their relative clinical effectiveness.Keywords: carotid artery stenting; carotid endarterectomy; micromesh stent; single layer stent; stroke
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.025 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.013 | 0.041 |
| Bibliometrics | 0.004 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".