Clinical significance of silent strokes in carotid artery surgery: a systematic review and meta-analysis

Abstract

Perioperative silent strokes are common in carotid artery surgery and detected only with magnetic resonance imaging. Clinical significance of these strokes is poorly understood, and available data are conflicting. Objective. To evaluate clinical consequences of perioperative silent strokes in patients undergoing carotid artery surgery. Material and methods. Meta-analysis was performed in accordance with PRISMA recommendations and Cochrane guidelines. Searching was carried out in the PubMed and Cochrane Library databases followed by forward and reverse snowballing. Study endpoints were the incidence of focal neurological deficit, postoperative cognitive dysfunction and death in patients with detected silent stroke (SS+ group) and without stroke (SS– group) after carotid artery interventions. Risk of bias was assessed using the CLARITY tool. Results. The study included 8065 patients. Of these, 2077 (25.8%) were diagnosed with perioperative silent stroke. No significant between-group differences in outcomes were found. The majority of studies had low quality. Conclusion. Despite no significant association between silent strokes and adverse outcomes, interpretation of results should be done with caution. Research prospects include assessing the long-term consequences and clinical significance of changes.