Mini-skin longitudinal incision versus traditional longitudinal incision for carotid endarterectomy in patients with carotid artery stenosis: a systematic review and meta-analysis.

Introduction: Carotid endarterectomy (CEA) remains the gold standard intervention for stroke prevention in patients with carotid artery stenosis but the surgical technique continues evolving with research being conducted on minimally invasive alternatives. Mini-skin incision CEA has emerged as a more aesthetically appealing and less painful alternative to the traditional technique with a potential impact on main procedural events. We aimed to provide a review of the literature and to compare the mini-skin incision with the traditional approach.

Evidence Acquisition: A systematic review was conducted following the PRISMA guidelines. Databases PubMed and Scopus were last searched on 20 July 2023. Procedural stroke, cranial/cervical nerves injury and mortality were defined as primary outcomes and length of hospitalization and minor complications as secondary outcomes. We included manuscripts comparing mini-skin with traditional incision CEA, and reporting our pre-established outcomes. The quality of studies was evaluated using the Newcastle-Ottawa Scale. We assessed heterogeneity and performed a meta-analysis for quantitative analysis when appropriate.

Evidence Synthesis: Five studies comprising a total of 2912 CEA procedures (2738 patients; 75.7% males) were included in both the qualitative and quantitative analysis. Compared with the traditional CEA, mini-skin incision led to a statistically significant decrease in periprocedural cranial/cervical nerve injury (OR 0.30, 95% CI 0.21, 0.43; P<0.01). Length of hospital stay and minor complications were significantly decreased in the mini-skin incision group (P<0.05). Concerning 30-day stroke rate and mortality no differences were attained.

Conclusions: Our results suggest that mini-skin incision CEA might be a safer approach, with the potential to significantly decrease the perioperative morbidity. Further studies are needed to confirm these preliminary findings and to reinforce the role of mini-skin incision CEA as a promising, less invasive alternative in the treatment armamentarium of carotid artery stenosis.