Carotid endarterectomy for symptomatic low-grade carotid artery stenosis

A study of Kyoto and Kurashiki, aimed to assess the safety, efficacy, and durability of carotid endarterectomy (CEA) for symptomatic low-grade carotid artery stenosis (LGS).

Study participants comprised 61 consecutive patients who underwent CEA for symptomatic carotid artery stenosis. Patients were divided into an LGS group (<50%, n=17) and a non-LGS group (≥50%, n=44). Patient characteristics and short- (within 30 days of CEA) and long-term outcomes were compared between groups for selective usage of internal shunt and the known complications of CEA.

MRI-detected intraplaque hemorrhage was more significant in LGS than in non-LGS (P = .04). For short-term outcomes, no symptomatic infarcts, hyperperfusion syndrome, or acute myocardial infarction (AMI) was confirmed in either group. Internal shunts were used in 4 LGS (23.5%) and 6 non-LGS (13.6%). Asymptomatic diffusion-weighted imaging-positive lesions were confirmed in 2 LGS patients (11.8%) and 5 non-LGS patients (11.4%), neck hematoma in 1 LGS patient, and transient cranial nerve palsy in 1 LGS patient and 2 non-LGS patients, with no significant differences apparent between groups. For long-term outcomes, 5 non-LGS patients showed restenosis (P = .17). Hemorrhagic stroke was not observed in either group. No significant differences were seen for infarct in the ipsilateral carotid territory, any ischemic stroke, AMI, or mortality.

CEA represents a safe and feasible therapeutic option for a subset of patients with symptomatic LGS 1).1) Yoshida K, Fukumitsu R, Kurosaki Y, Nagata M, Tao Y, Suzuki M, Yamamoto Y, Funaki T, Kikuchi T, Ishii A, Miyamoto S. Carotid Endarterectomyfor Medical Therapy-resistant Symptomatic Low-grade Stenosis. World Neurosurg. 2018 Dec 3. pii: S1878-8750(18)32767-0. doi: 10.1016/j.wneu.2018.11.208. [Epub ahead of print] PubMed PMID: 30521960.

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