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

World Neurosurg. 2019 Mar;123:e543-e548. doi: 10.1016/j.wneu.2018.11.208. Epub 2018 Dec 3.


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.

Keywords: Carotid endarterectomy; Expansive remodeling; Low-grade stenosis; Vulnerable plaque.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Carotid Stenosis / diagnostic imaging
  • Carotid Stenosis / surgery*
  • Endarterectomy, Carotid*
  • Female
  • Follow-Up Studies
  • Humans
  • Intracranial Hemorrhages / diagnostic imaging
  • Intracranial Hemorrhages / surgery
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Postoperative Complications
  • Retrospective Studies
  • Severity of Illness Index
  • Treatment Outcome