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Correspondence on “Unplanned readmission after carotid stenting versus endarterectomy: analysis of the United States Nationwide Readmissions Database" by Nazari et al
  1. Ahmed Y Azzam1,
  2. Sherief Ghozy2,
  3. Kevin M Kallmes1,
  4. Adam A Dmytriw3,
  5. Ramanathan Kadirvel2,
  6. David F Kallmes2
  1. 1Nested Knowledge Inc, Saint Paul, Minnesota, USA
  2. 2Department of Radiology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
  3. 3Neuroendovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Sherief Ghozy, Department of Radiology, Mayo Clinic Minnesota, Rochester, MN 55905, USA; ghozy.sherief{at}

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We read the article by Nazari et al1 comparing carotid endarterectomy and carotid artery stenting. Most of the patients in the article were asymptomatic patients.

Asymptomatic carotid stenosis is considered one of the most significant causes of ischemic stroke. The management of asymptomatic carotid stenosis ranges from open surgical approaches to minimally invasive endovascular interventions and medical therapeutics.2 With the advances in the neurosurgical field within the last decade, various surgical interventions have emerged. However, to date, the evidence regarding the optimal interventional strategies for asymptomatic carotid stenosis is controversial and discordant.

Several overlapping meta-analyses have analyzed the safety and efficacy of carotid endarterectomy compared with carotid stenting for asymptomatic carotid stenosis.3–7 Nevertheless, the conflicting findings of these studies lead to inconsistency, making it challenging to draw firm conclusions. We therefore analyzed the overlapping results of the current evidence to provide a more unified summary of treatment choice.


A comprehensive search was conducted for all relevant studies published up to February 16, 2022 using the following databases: PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, OVID, and Google Scholar. The relevant keywords included ‘Carotid Endarterectomy AND Carotid Stenosis’, ‘Carotid Endarterectomy AND Asymptomatic Carotid Stenosis’, ‘Carotid Stenting AND Carotid Stenosis’, ‘Carotid Stenting AND Carotid Stenosis’, ‘Carotid Stenting AND Asymptomatic Carotid …

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  • Contributors AYA, SG, and KMK contributed to the conception, design of the work, and revising it critically for important intellectual content. AYA performed the statistical analysis. All authors contributed to the acquisition, interpretation of data, and drafting of the work. All authors approved the final version of the manuscript to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding Research reported in this publication was supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under Award Number R01NS076491. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

  • Competing interests KMK works for and holds equity in Nested Knowledge Inc, works for Conway Medical LLC, and holds equity in Superior Medical Experts, Inc. DFK has the following conflicts: ownership in Nested Knowledge Inc, Superior Medical Experts Inc, Conway Medical LLC; research support from Microvention, Balt USA, Medtronic.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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