Carotid Artery Endarterectomy in Patients with Symptomatic Non-stenotic Carotid Artery Disease

Overview

Journal Stroke Vasc Neurol

Specialty Cardiology & Vascular Diseases

Date 2022 Mar 4

PMID 35241631

Authors

Valentina Nardi

John C Benson

Anthony S Larson

Waleed Brinjikji

Luca Saba

Fredric B Meyer

Giuseppe Lanzino

Amir Lerman

Luis E Savastano

Affiliations

Soon will be listed here.

Abstract

Object: We sought to determine the safety and efficacy in secondary stroke prevention of carotid endarterectomy (CEA) in patients with symptomatic non-stenotic carotid artery disease (SyNC).

Methods: This was a single-centre retrospective case series. All patients who underwent CEA for unilateral anterior circulation cerebrovascular events with ipsilateral <50% carotid stenosis from 2002 to 2020 were included. Imaging hallmarks including the degree of luminal stenosis and the presence of various vulnerable plaque characteristics (eg, intraplaque haemorrhage (IPH) on MR angiography, ulceration or low-density plaque on CT angiography) were assessed. The presence of vulnerable plaque characteristics was compared between arteries ipsilateral to the ischaemic event and contralateral arteries. The prevalence of perioperative/intraoperative complications, as well as recurrent ischaemic events at follow-up was determined.

Results: Thirty-two patients were included in the analysis, of which 25.0% were female. Carotid arteries ipsilateral to an ischaemic event had a significantly higher prevalence of IPH when compared with contralateral arteries (80.0% vs 0.0%; p<0.001). There were no intraoperative complications. One patient (3.1%) developed symptoms of transient ipsilateral ischaemia 1 day following CEA which resolved without treatment. In a median follow-up of 18.0 months (IQR 5.0-36.0), only one patient (3.1%) experienced a transient neurologic deficit with complete resolution (annualised rate of recurrent stroke after CEA of 1.5% for a total follow-up of 788 patient-months following CEA). All other patients (31/32, 96.9%) were free of recurrent ischaemic events.

Conclusion: CEA appears to be safe and well-tolerated in patients with SyNC. Additional studies with larger cohorts and longer follow-up intervals are needed in order to determine the role of CEA in this patient population.

Citing Articles

MR Imaging of Carotid Artery Atherosclerosis: Updated Evidence on High-Risk Plaque Features and Emerging Trends.

Benson J, Saba L, Bathla G, Brinjikji W, Nardi V, Lanzino G AJNR Am J Neuroradiol. 2023; 44(8):880-888.

PMID: 37385681 PMC: 10411837. DOI: 10.3174/ajnr.A7921.

Nonstenotic Carotid Plaques and Embolic Stroke of Undetermined Source: A Multimodality Review.

Larson A, Brinjikji W, Lekah A, Klaas J, Lanzino G, Huston J AJNR Am J Neuroradiol. 2022; 44(2):118-124.

PMID: 36549844 PMC: 9891333. DOI: 10.3174/ajnr.A7750.

Endarterectomy for symptomatic non-stenotic carotids: a systematic review and descriptive analysis.

Larson A, Nardi V, Brinjikji W, Benson J, Lanzino G, Savastano L Stroke Vasc Neurol. 2021; 7(1):6-12.

PMID: 34244446 PMC: 8899633. DOI: 10.1136/svn-2021-001122.

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