Literature Search: A literature search will be conducted across the databases of PubMed, Embase and Cochrane. Keywords include "carotid endarterectomy", "CEA", "seizures", and "epilepsy". Additional studies are to be obtained from Google Scholar and from hand-searching within the references of previous studies.
Inclusion and Exclusion Criteria: The study’s inclusion criteria includes: (a) patients diagnosed with seizures or with a history of epilepsy; (b) patients eligible for CEA; (c) participants aged 18 years or older; (d) reporting on post-CEA seizures or epi-lepsy; (e) reporting on cerebral hyperperfusion syndrome or related complications (e.g., hypertension, hypoperfusion); (f) data on pre-operative or post-operative blood pressure control and (f) studies with robust methodological design and a minimum sample size of 20 patients per group. Criteria for exclusion include: (1) animal studies; (2) duplicate publications; (3) inaccessibility of the full-text article; (4) studies presented solely in the abstract form, without pertinent CEA-related data or relevant post-reperfusion clinical outcomes assessed; and (5) case reports or editorials.
Data Extraction: From the studies included in the meta-analysis, data is to be extracted and organized into a comprehensive spreadsheet. Information to be extracted includes study characteristics, CEA procedure cohort, patient comorbidities and the presence of seizures post-CEA.
Statistical analyses: STATA (Version 13.0, StataCorp, College Station, TX, USA) will be used for statistical analyses. The "midas" package in STATA will be used to perform meta-analyses with the 'metaprop' command to generate pooled prevalence estimates, using a random-effects model, which will be the primary measure of the prevalence of seizures post-CEA. For odds ratios (ORs), 95% confidence intervals (95% CIs), proportionate weights and heterogeneity across incorporated studies, forest plots were generated, particularly for the association between pre-operative hypertension and seizures post-CEA.
