This meta-analysis aims to evaluate the efficacy of endovascular carotid artery stenting in comparison to open carotid revascularization techniques in treating radiation-induced carotid artery stenosis.

Cervical irradiation is well known to cause carotid artery stenosis. The benefit of an endovascular approach in treating radiation-induced carotid artery stenosis has not been well studied. 

A comprehensive search was conducted in major medical databases. The primary outcome studied was 30-day stroke and mortality rates. Secondary outcomes studied included late mortality and restenosis rates.  The statistical analysis was performed in R-Studio. The Mantel-Haenszel method (common effect model) and the Inverse variance method (random effects model) were used to obtain Risk ratios. The I^2 test was used to determine the heterogeneity between studies.

544 articles were screened with 9 full-text articles retrieved. After various exclusions, 6 articles were used in the final analysis.

The meta-analysis involved 6 studies with 611 patients undergoing an endovascular approach and 1251 patients undergoing conventional open carotid revascularization techniques. The analysis indicated that the risk of early stroke, and early mortality was similar in both the groups.  There was a significant reduction in the risk of cranial nerve injury following the endovascular approach [RR=0.23 (95%CI, p = 0.13, I^2 = 43%)]. The risk of late restenosis was higher in the Endovascular treatment group [RR=1.45(95%CI, p = 0.95, I^2 = 0%) 

Endovascular Carotid Artery Stenting (ECAS) shows significant benefits in comparison to Open Carotid Revascularization Techniques (OCRT) in the treatment of Radiation-Induced Carotid Artery Stenosis. The Endovascular approach showed a considerably lower risk of Cranial Nerve Injury. The risk of early stroke and early mortality were found to be similar in both groups while the incidence of late re-stenosis was increased in the Endovascular approach.