Purpose <p>To evaluate the association between hemodynamic depression (HD) during CAS and major adverse cardiovascular events (MACE).</p> Methods <p>We systematically searched four major databases for studies reporting the HD and MACE during CAS. The risk of bias in the included studies was assessed using a modified version of Newcastle–Ottawa scale. The heterogeneity between the studies was evaluated based on the <i>I</i>² statistic and Dixon’s Q‐test. We assessed heterogeneity using the <i>I</i>² statistic. A fixed-effect model was used if <i>I</i>² &lt; 50%; otherwise, a random-effects model was applied. Results were reported as ORs with 95% CIs. Funnel plots and Egger’s test were used to evaluate the publication bias.</p> Results <p>Fourteen studies comprising 4418 patients were included in the meta-analysis. Evidence of low certainty indicated that the occurrence of HD was significantly associated with an increased risk of stroke (OR 2.12, 95% CI 1.4–3.22, <i>I</i>² = 0), transient ischemic attack (TIA) (OR 2.72, 95% CI 1.51–4.88, <i>I</i>² = 41.2), and all-cause mortality (OR 2.81, 95% CI 1.22–6.44, <i>I</i>² = 0). However, very low-certainty evidence suggested no significant association between HD and myocardial infarction (MI) (OR 1.49, 95% CI 0.61–3.61, <i>I</i>² = 0).</p> Conclusions <p>HD during CAS is significantly associated with a risk of TIA, stroke, and all-cause mortality, but not with the risk of MI.</p> Graphical Abstract <p></p>