Carotid Endarterectomy for Medical Therapy-Resistant Symptomatic Low-Grade Stenosis.

Abstract:

BACKGROUND:Plaque characteristics play pivotal roles in ischemic events, but stenosis severity does not accurately reflect carotid plaque volume due to expansive remodeling in some patients with low-grade stenosis (LGS). This study aimed to assess the safety, efficacy, and durability of carotid endarterectomy (CEA) for symptomatic LGS. METHODS:Study participants comprised 61 consecutive patients who underwent CEA for symptomatic carotid stenosis. Patients were divided into an LGS group (<50%, n = 17) and a non-LGS group (≥50%, n = 44). Patient characteristics and short-term (within 30 days of CEA) and long-term outcomes were compared between groups for selective usage of internal shunt and known complications of CEA. RESULTS:Magnetic resonance imaging-detected intraplaque hemorrhage was more significant in LGS than in non-LGS (P = 0.04). For short-term outcomes, no symptomatic infarcts, hyperperfusion syndrome, or acute myocardial infarction 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 = 0.17). 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. CONCLUSIONS:CEA represents a safe and feasible therapeutic option for a subset of patients with symptomatic LGS.

journal_name

World Neurosurg

journal_title

World neurosurgery

authors

Yoshida K,Fukumitsu R,Kurosaki Y,Nagata M,Tao Y,Suzuki M,Yamamoto Y,Funaki T,Kikuchi T,Ishii A,Miyamoto S

doi

10.1016/j.wneu.2018.11.208

subject

Has Abstract

pub_date

2019-03-01 00:00:00

pages

e543-e548

eissn

1878-8750

issn

1878-8769

pii

S1878-8750(18)32767-0

journal_volume

123

pub_type

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