Objective To compare the long-term efficacy of carotid artery stenting (CAS) and carotid endarterectomy (CEA) in the treatment of carotid artery stenosis by meta-analysis. Methods PubMed, Embase, Medline, Cochrane Library, China National Knowledge Infrastructure, Wanfang database, Chongqing VIP database, and SinoMed were searched, for randomized controlled trials comparing the efficacy of CAS and CEA in the treatment of carotid artery stenosis published before September 2nd, 2021. Stata 15.1 software was used to analyze the long-term outcome data, including any stroke, ipsilateral stroke, fatal or disabling stroke, any death, combined endpoint of stroke or death, and carotid artery restenosis. Results A total of 20 English articles from 9 studies were included, involving 8551 patients (4658 in the CAS group and 3893 in the CEA group). The medians of the follow-up time of these studies were 2-10 years. The meta-analysis showed that the risks of any stroke [hazard ratio (HR)=1.33, 95% confidence interval (CI) (1.16, 1.52), P<0.0001], ipsilateral stroke [HR=1.26, 95%CI (1.02, 1.55), P=0.034], and the combined endpoint of stroke or death [HR=1.17, 95%CI (1.02, 1.33), P=0.021] in the CAS group were significantly higher than those in the CEA group, while the risks of fatal or disabling stroke [HR=1.19, 95%CI (0.94, 1.51), P=0.152], any death [HR=1.06, 95%CI (0.95, 1.18), P=0.302], and restenosis [HR=1.20, 95%CI (0.96, 1.49), P=0.111] were not significantly different between the CAS group and the CEA group. Conclusions CAS and CEA have similar risks in terms of long-term fatal or disabling stroke, death, and carotid artery restenosis, but the long-term risks of any stroke, ipsilateral stroke and combined endpoint of death or stroke of CAS are higher than those of CEA. CEA is still the preferred non-drug method for carotid artery stenosis.
In November 2025, the American Academy of Orthopaedic Surgeons (AAOS) released the updated Clinical Practice Guideline for the Management of Acute Compartment Syndrome (ACS). This guideline addresses key issues including early diagnostic strategies, surgical decision-making, and perioperative management, presenting 8 recommendations and 7 consensus statements. A systematic interpretation highlights the core recommendations regarding the diagnostic value of biomarkers, the important role of compartment pressure monitoring, surgical decision-making, and wound management. A major update is the upgrade of the recommendation for early fixation of long bone fractures in ACS patients with associated fractures from expert consensus to a limited recommendation. Compared with the Chinese Guideline for Early Diagnosis and Treatment of Acute Compartment Syndrome (2020 edition), there were three key similarities and differences. Diagnostic strategy: both guidelines value compartment pressure monitoring, but the Chinese guideline emphasizes its diagnostic role, whereas the AAOS guideline focuses on its utility in dynamic monitoring to help rule out ACS. Biomarkers: Chinese guidelines suggests that serum lactate, serum cardiac troponin, and myoglobinuria may serve as indicators of traumatic ACS; the AAOS guideline only recognizes myoglobinuria, serum troponin, and, in specific contexts, femoral venous lactate as having adjunctive value, and explicitly states that serum biomarkers should not be used as the basis for fasciotomy decision-making in late or missed ACS. Treatment: both guidelines emphasize that once the diagnosis is confirmed, early fasciotomy should be performed. The AAOS guideline provides a reference for Chinese clinicians to improve early recognition and standardized management of ACS.