Procedure Speed in Carotid Stenting: A Systematic Review and Meta-analysis of Outcomes

Introduction: Managing carotid artery stenosis is crucial for stroke prevention, and carotid artery stenting (CAS) is a less invasive alternative to endarterectomy for high-risk patients. The “up-down time”—the period of active manipulation during stent placement and balloon inflation—could impact CAS outcomes like complication rates, morbidity, and mortality. While shorter up-down times may minimize risks associated with prolonged artery handling, rushing could introduce errors. This review analyzes the relationship between procedure speed and CAS outcomes.

Methods: This systematic review adhered to PRISMA guidelines, searching PubMed, EMBASE, and Web of Science for relevant studies from inception to October 2024. Inclusion criteria were studies reporting on procedural metrics and outcomes in CAS. Data were extracted using Covidence and analyzed with Microsoft Excel and JMP. The quality of studies was assessed using the Joanna Briggs Institute tool. Statistical tests included analysis of variance (ANOVA) and nonparametric Wilcoxon tests to evaluate differences in outcomes based on procedural times.

Results: A total of 63 studies, encompassing 124,332 patients, were analyzed. The mean total procedural time was 58.85 minutes, with a mean fluoroscopy duration of 14.87 minutes. The overall mean complication rate was 11.6%. Notably, operator experience emerged as a critical determinant of outcomes, with a significant reduction in adverse events observed when procedures were conducted by more experienced practitioners.

Conclusion : Our analysis indicates that while shorter procedural times may reduce certain risks, fluoroscopy duration and operator experience remain critical in achieving optimal outcomes. Future research should aim to standardize training and refine procedural techniques to minimize complications while ensuring procedural efficiency.