Efficacy of Carotid Endarterectomy for Mild (<50%) Symptomatic Carotid Stenosis with Unstable Plaque

World Neurosurgery
Daina KashiwazakiSatoshi Kuroda

Abstract

Carotid endarterectomy (CEA) is known to reduce stroke risk in patients with symptomatic, moderate to severe carotid stenosis but has no apparent impact in patients with symptomatic, mild (less than 50%) carotid stenosis. However, recent development of noninvasive imaging modalities has shown that a certain subgroup of patients are at high risk for further ischemic events despite antiplatelet therapy. This study, therefore, aimed to clarify the patients' clinical features and explore the impact of CEA for them. This prospective cohort study included 74 patients who underwent CEA for symptomatic carotid stenosis between April 2012 and December 2016. Of these, 16 (22%) had mild (less than 50%) carotid stenosis. Their demographic, radiologic, intraoperative, and pathologic findings were precisely analyzed, and their outcome after CEA was examined for 38.5 ± 13.3 months. Of these 16 patients, 12 had already been treated with antiplatelets against previous ischemic cerebrovascular or coronary artery diseases. Plaque magnetic resonance imaging revealed that all patients had vulnerable plaque, including lipid-rich plaque (n = 6) and intraplaque hemorrhage (n = 10). Intraoperative observations confirmed this. Histologic analysis reveal...Continue Reading

Citations

Jan 18, 2020·Stroke; a Journal of Cerebral Circulation·Raffaella BerchiolliRiemer H J A Slart
Mar 7, 2020·Stroke; a Journal of Cerebral Circulation·Mayank GoyalJohanna M Ospel
Jul 11, 2020·AJNR. American Journal of Neuroradiology·N SinghM Almekhlafi
May 19, 2021·Ultrasound in Medicine & Biology·Chung-Ming Lo, Peng-Hsiang Hung
Jul 11, 2021·Stroke and Vascular Neurology·Anthony LarsonLuis Savastano
Dec 7, 2021·Asian Cardiovascular & Thoracic Annals·Şenol YavuzTamer Türk

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