Restenosis of carotid or intracranial (IC) arteries following revascularization is associated with increased ischemic stroke risk. A systematic review and study-level meta-analysis published in the Atherosclerosis Plus examined whether preprocedural C-reactive protein (CRP), a marker of systemic inflammation, is associated with subsequent carotid or IC restenosis.

Databases including PubMed, EMBASE, MEDLINE, Scopus, and Web of Science were searched through August 31, 2025. Twelve case-control studies comprising 2040 participants (325 restenosis cases; 1715 controls without restenosis) were included. Pooled standard mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using a random-effects model.
Preprocedural CRP levels were higher in patients who developed restenosis compared with those who did not (SMD 0.50; 95% CI 0.11–0.89; p=0.01). No apparent publication bias was identified using Begg’s funnel plot or Egger’s test (p=0.51). Leave-one-out sensitivity analysis supported the robustness of findings.

Limitations include high heterogeneity due to varied study designs, imaging definitions, and follow-up durations; lack of uniform adjustment for confounders; potential measurement variability across CRP assays; absence of blinded restenosis assessment; and predominance of small retrospective studies.

Preprocedural CRP levels were associated with subsequent carotid or intracranial restenosis in pooled analyses. Prospective, methodologically uniform studies are needed to confirm these findings and clarify clinical implications.