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There is an increasing number of studies on the transradial approach (TRA) for carotid artery stenting. We aimed to summarize the published data on TRA vs the transfemoral approach (TFA). We searched Science Direct, Embase, PubMed, and Web of Science databases for the relevant literature. Primary outcomes included surgical success and cardiovascular and cerebrovascular complication rates; secondary outcomes included the rates of vascular access-related and other complications. We also compared the crossover rate, success rate, and complications between TRA and TFA carotid stenting. This is the first such meta-analysis regarding TRA and TFA. Twenty studies on TRA carotid stenting were included (n = 1300). Among 19 studies, the success rate of TRA carotid stenting was.951 (95% confidence interval [CI]:.926–.975); death rate was.022 (.011–.032); stroke rate was.005 (.001–.008); radial artery occlusion rate was.008 (.003–.013); and forearm hematoma rate was.003 (−.000 to.006). Among 4 studies comparing TRA and TFA, the success rate was lower (odds ratio:.02; 95% CI:.00–.23) and crossover rate was higher (odds ratio: 40.16; 95% CI: 4.41–365.73) with TRA. Thus, transradial neuro-interventional surgery has a lower success rate than TFA. [ABSTRACT FROM AUTHOR]