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Treatment strategies for asymptomatic carotid artery stenosis in the era of lipid-lowering drugs: protocol for a systematic review and network meta-analysis
  1. Xuesong Bai1,
  2. Yao Feng1,
  3. Long Li1,
  4. Kun Yang2,
  5. Tao Wang1,
  6. Jichang Luo1,
  7. Xue Wang3,
  8. Feng Ling1,
  9. Yan Ma1,
  10. Liqun Jiao1
  1. 1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
  2. 2Department of Evidence-based Medicine, Xuanwu Hospital, Beijing, China
  3. 3Medical Library, Xuanwu Hospital, Capital Medical University, Beijing, China
  1. Correspondence to Dr Liqun Jiao; liqunjiao{at}


Introduction Carotid endarterectomy (CEA), carotid artery stenting (CAS) and best medical therapy (BMT) are the major treatments used for significant asymptomatic carotid artery stenosis (ACAS, ≥50%). However, the widespread use of lipid-lowering drugs in this century has improved BMT outcomes. This study aims to compare the treatment efficacy of current BMT, CEA+BMT and CAS+BMT in patients with significant ACAS.

Methods and analysis This protocol was designed based on the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Publication time for studies will be set from 1 January 2000 to 1 June 2020. We will search three databases: PubMed, EMBASE and The Cochrane Library. Suitable randomised controlled studies will be screened. The primary outcomes will include short-term and long-term mortality, stroke and myocardial infarction. OR and HR for dichotomous data and time-to-event data with 95% CIs will be calculated. Treatment effects among different therapies will be ranked according to the surface under the cumulative ranking curve and mean rank. A comprehensive evaluation of the risk of bias, heterogeneity and transitivity will be performed before data synthesis. Consistency and evidence quality will also be assessed.

Ethics and dissemination There will be no need for ethics approval as this systematic review is a summary and analysis of existing literature. Final results may be presented in international conferences or a peer-reviewed journal.

PROSPERO registration number CRD42019138942.

  • stroke medicine
  • stroke
  • neurosurgery

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  • XB, YF and LL contributed equally.

  • Contributors XB, TW and JL developed the initial idea for this study. XB, XW and KY developed and revised the search strategy. XB, TW, JL and LJ finished the study design. LJ, FL and YM were consulted about clinical issues. XB, YF and TW contributed to the original draft. XB, YF, LL, FL and LJ and were responsible for the revision of the draft. All of the authors approved the final work prior to submission.

  • Funding The study was funded by the National Key Research and Development Project (2016YFC1301703) and the Beijing Scientific and Technologic Project (D161100003816002).

  • Disclaimer The funder has no role in study design, data analysis and writing the manuscript.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

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