{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T07:02:06Z","timestamp":1771225326452,"version":"3.50.1"},"reference-count":30,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,6,15]],"date-time":"2025-06-15T00:00:00Z","timestamp":1749945600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,6,15]],"date-time":"2025-06-15T00:00:00Z","timestamp":1749945600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Carotid artery stenting (CAS) is widely used to treat carotid artery stenosis. However, compared with carotid endarterectomy, CAS has been associated with a higher risk of peri\u2010procedural stroke. Recently, dual\u2010layered stents (DLS) have demonstrated a lower risk of peri\u2010 and post\u2010procedural stroke. We conducted a meta\u2010analysis to evaluate the safety and efficacy of DLS in lowering stroke risk in patients undergoing CAS for carotid artery stenosis. A systematic search was performed through PubMed, Scopus, Embase, and Cochrane Library from inception until July 2024 for studies comparing DLS and single\u2010layered stents (SLS) in patients with high\u2010risk, lipid\u2010rich carotid plaques. The primary outcome was peri\u2010 and postprocedural stroke. Secondary outcomes included stent occlusion, restenosis, and all\u2010cause mortality. A random\u2010effects meta\u2010analysis derived risk ratios (RR) with 95% confidence intervals. Out of 395 results, 7 observational studies and 3 randomized controlled trials (RCTs) were included, totaling 2214 patients undergoing 2256 CAS procedures (1513 with DLS, 743 with SLS). Peri\u2010 and postprocedural stroke (RR: 0.33, 95% CI: 0.18\u20130.61;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.0003;\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u20090%) was significantly lower with DLS. Stent occlusion (RR: 0.66, 95% CI: 0.20\u20132.24,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.51,\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u20090%), restenosis (RR: 1.08, 95% CI: 0.34\u20133.48,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.90,\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u200961%), and all\u2010cause mortality (RR: 0.83, 95% CI: 0.17\u20134.11,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.82,\n                    <jats:italic>I<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u200936%) were similar between stent types. Meta\u2010regression found no significant predictors of stroke, including age, sex, hypertension, smoking, diabetes, and dyslipidemia. DLS use in CAS is associated with a lower risk of peri\u2010 and post\u2010procedural stroke compared with SLS. This lower stroke risk should be considered in weighing CAS treatment options.\n                  <\/jats:p>","DOI":"10.1002\/ccd.31684","type":"journal-article","created":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T02:22:35Z","timestamp":1750040555000},"page":"1324-1334","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Systematic Review and Meta\u2010Analysis of Dual\u2010Layered Stents Versus Single\u2010Layered Stents for Carotid Artery Stenosis"],"prefix":"10.1002","volume":"106","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-2043-9565","authenticated-orcid":false,"given":"Tahreem","family":"Mari","sequence":"first","affiliation":[{"name":"Dow Medical College Karachi Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdul","family":"Moeed","sequence":"additional","affiliation":[{"name":"Dow Medical College Karachi Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdul Hannan","family":"Siddiqui","sequence":"additional","affiliation":[{"name":"Dow Medical College Karachi Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arooba Noor","family":"Abbasi","sequence":"additional","affiliation":[{"name":"Dow Medical College Karachi Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zainab","family":"Arif","sequence":"additional","affiliation":[{"name":"Department of Medicine Jinnah Sindh Medical University Karachi Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aleesha","family":"Jannat","sequence":"additional","affiliation":[{"name":"Department of Medicine Jinnah Sindh Medical University Karachi Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zafer","family":"Akman","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine Yale School of Medicine New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6898-2192","authenticated-orcid":false,"given":"Raiza","family":"Rossi","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine Yale School of Medicine New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haseeb Ali","family":"Unnar","sequence":"additional","affiliation":[{"name":"Liaquat National Medical College Karachi Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hassam Abdul Rehman","family":"Bhatti","sequence":"additional","affiliation":[{"name":"Liaquat National Medical College Karachi Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rida","family":"Batool","sequence":"additional","affiliation":[{"name":"Jinnah Medical and Dental College Karachi Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad Omar Farooq","family":"Khan","sequence":"additional","affiliation":[{"name":"Liaquat National Medical College Karachi Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad Taha","family":"Ali","sequence":"additional","affiliation":[{"name":"Liaquat National Medical College Karachi Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fizza","family":"Batool","sequence":"additional","affiliation":[{"name":"Jinnah Medical and Dental College Karachi Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"family":"Minahil","sequence":"additional","affiliation":[{"name":"United Medical and Dental College Karachi Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2627-685X","authenticated-orcid":false,"given":"Javed","family":"Iqbal","sequence":"additional","affiliation":[{"name":"Hamad Medical Corporation Doha Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos","family":"Mena\u2010Hurtado","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine Yale School of Medicine New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5745-1636","authenticated-orcid":false,"given":"Michael G.","family":"Nanna","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine Yale School of Medicine New Haven Connecticut 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