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Use of patch angioplasty to restore the arterial wall after longitudinal endarterectomy is, to date, not unequivocally proven to be superior to eversion technique. A systematic review is needed for evaluation of benefits and harms of the eversion technique versus the traditional endarterectomy with patch angioplasty in patients with symptomatic carotid stenosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and outcomes<\/jats:title>\n                    <jats:p>The review will be conducted according to this protocol following the recommendations of the \u2018Cochrane Handbook for Systematic Reviews\u2019 and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Randomised clinical trials comparing eversion technique versus endarterectomy with patch angioplasty in patients with a symptomatic stenosis of the internal carotid artery will be included. Primary outcomes are all-cause mortality rate, health-related quality of life and serious adverse events. Secondary outcomes are 30-day stroke and mortality rate, symptomatic arterial restenosis or occlusion and non-serious adverse events. The databases Cochrane Central Register of Controlled Trials, PubMed\/MEDLINE and EMBASE will be searched (November 2019). We will primarily base our conclusions on meta-analyses of trials with overall low-risk of bias. We will use trial sequential analysis to assist the evaluation of imprecision in Grading of Recommendations, Assessment, Development and Evaluation. However, if pooled point estimates of all trials are similar to pooled point estimates of trials with overall low risk of bias and there is lack of a statistical significant interaction between estimates from trials with overall high risk of bias and trials with overall low risk of bias we will consider the trial sequential analysis adjusted precision of the estimate achieved in all trials as the result of our meta-analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The proposed systematic review will collect and analyse data from published studies, therefore, ethical approval is not required. The results of the review will be disseminated by publication in a peer-review journal and submitted for presentation at conferences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42019119361.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-030503","type":"journal-article","created":{"date-parts":[[2020,4,20]],"date-time":"2020-04-20T06:19:28Z","timestamp":1587363568000},"page":"e030503","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Eversion technique versus conventional endarterectomy with patch angioplasty in carotid surgery: protocol for a systematic review with meta-analyses and trial sequential analysis of randomised clinical trials"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9819-8080","authenticated-orcid":false,"given":"Martijn S.","family":"Marsman","sequence":"first","affiliation":[{"name":"Department of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7778-1771","authenticated-orcid":false,"given":"Jorn","family":"Wetterslev","sequence":"additional","affiliation":[{"name":"Rigshospitalet, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick W.H.E.","family":"Vriens","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronald L.A.W.","family":"Bleys","sequence":"additional","affiliation":[{"name":"Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdelkarime Kh.","family":"Jahrome","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, HFG, Medical Center Leeuwarden, Leeuwarden, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frans L.","family":"Moll","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frederik","family":"Keus","sequence":"additional","affiliation":[{"name":"Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giel G.","family":"Koning","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Ikazia Hospital, Rotterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,4,19]]},"reference":[{"key":"2025121512032485000_10.4.e030503.1","doi-asserted-by":"publisher","DOI":"10.1001\/archneurpsyc.1951.02320030083009"},{"key":"2025121512032485000_10.4.e030503.2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-158-9-201305070-00007"},{"key":"2025121512032485000_10.4.e030503.3","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.556068"},{"key":"2025121512032485000_10.4.e030503.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2013.06.085"},{"key":"2025121512032485000_10.4.e030503.5","article-title":"Carotid endarterectomy for symptomatic carotid stenosis","volume":"6","author":"Orrapin","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121512032485000_10.4.e030503.6","doi-asserted-by":"publisher","DOI":"10.1001\/archneurol.2010.262"},{"key":"2025121512032485000_10.4.e030503.7","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.1016\/0140-6736(91)92916-P","article-title":"MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis","volume":"337","author":"Warlow","year":"1991","journal-title":"The Lancet"},{"key":"2025121512032485000_10.4.e030503.8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199108153250701"},{"key":"2025121512032485000_10.4.e030503.9","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.ejvs.2017.06.021","article-title":"Editor's Choice - 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