{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T07:04:01Z","timestamp":1790665441334,"version":"4.1.0"},"reference-count":38,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":27,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"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":["Journal of Neuroimaging"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Management of asymptomatic carotid stenosis (ACS) remains controversial, particularly as contemporary optimal medical therapy (OMT) has evolved beyond the aspirin\u2010based regimens used in earlier trials. We performed a meta\u2010analysis comparing carotid revascularization plus OMT versus OMT alone in patients with ACS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched five databases (PubMed, Embase, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials [CENTRAL]) from inception to November 2025. Randomized controlled trials comparing carotid revascularization (endarterectomy or stenting) plus OMT versus OMT alone were included. Primary outcomes were 30\u2010 to 44\u2010day mortality and stroke. Other outcomes included long\u2010term all\u2010cause mortality, stroke, myocardial infarction, and intracerebral hemorrhage. All statistical analyses were performed in R, and risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using either fixed\u2010 or random\u2010effects models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Six trials involving 8276 patients were included. Revascularization significantly increased 30\u2010 to 44\u2010day mortality (RR 3.98 [95% CI, 1.53\u201310.35],\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.0046) and stroke risk (RR 4.53 [95% CI, 2.51\u20138.17],\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.0001). However, long\u2010term follow\u2010up demonstrated significant reductions in all\u2010cause mortality (RR 0.80 [95% CI, 0.68\u20130.93],\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.0053) and stroke (RR 0.66 [95% CI, 0.57\u20130.76],\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.0001). No significant differences were observed in myocardial infarction or intracerebral hemorrhage rates.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Carotid revascularization combined with OMT was associated with increased periprocedural risks but lower long\u2010term stroke and mortality in pooled analyses of patients with ACS. These findings should be interpreted cautiously given differences across trials and evolving OMT standards. Patient selection should balance procedural risks against potential long\u2010term benefit, particularly among patients with high\u2010grade stenosis, low periprocedural risk, and access to experienced centers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jon.70148","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T06:35:10Z","timestamp":1790663710000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Revascularization Plus Medical Therapy Versus Medical Therapy Alone for Asymptomatic Carotid Stenosis: A Meta\u2010Analysis"],"prefix":"10.1111","volume":"36","author":[{"given":"Mohammed M.","family":"Al\u2010Salihi","sequence":"first","affiliation":[{"name":"Department of Neurology, Yale School of Medicine Yale University  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam S.","family":"Al\u2010Jebur","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, School of Medicine and Public Health University of Wisconsin\u2013Madison  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Rizvi","sequence":"additional","affiliation":[{"name":"Desert Regional Medical Center  Palm Springs California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Saleh","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery University of Arizona, College of Medicine Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ufuk","family":"Erginoglu","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, School of Medicine and Public Health University of Wisconsin\u2013Madison  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farhan","family":"Siddiq","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery University of Missouri  Columbia Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Ayyad","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Jordan University Hospital  Amman Jordan"},{"name":"Department of Neurosurgery, School of Medicine University of Jordan  Amman Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa K.","family":"Baskaya","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, School of Medicine and Public Health University of Wisconsin\u2013Madison  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adnan I.","family":"Qureshi","sequence":"additional","affiliation":[{"name":"Zeenat Qureshi Stroke Institute and Department of Neurology University of Missouri  Columbia Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"e_1_2_12_2_1","volume-title":"StatPearls","author":"Koch K.","year":"2025"},{"key":"e_1_2_12_3_1","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1161\/STROKEAHA.108.532218","article-title":"Prevalence of Asymptomatic Carotid Artery Stenosis According to Age and Sex: Systematic Review and Metaregression Analysis","volume":"40","author":"Weerd M.","year":"2009","journal-title":"Stroke; A Journal of Cerebral Circulation"},{"issue":"5","key":"e_1_2_12_4_1","doi-asserted-by":"crossref","first-page":"370","DOI":"10.7326\/M14-1332","article-title":"Screening for Asymptomatic Carotid Artery Stenosis: Caveat Emptor","volume":"161","author":"Goldstein L. 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