Asymptomatic vs. Symptomatic Carotid Revascularization: A Single Institution Retrospective Review.

Background

While carotid revascularization reduces stroke risk in both asymptomatic (AD) and symptomatic (SD) carotid disease, its role continues to evolve with advances in medical therapy, surgical techniques, and cost considerations.

Methods

This retrospective study reviews outcomes of patients undergoing revascularization at a level one stroke center between 2019 and 2024. Primary endpoints were ipsilateral stroke, myocardial infarction, and death at 30-day, 90-day, and 1-year. Secondary endpoints include restenosis rates.

Results

113 patients underwent 127 carotid endarterectomies. Sixty-four percent presented with SD, with a median time to intervention of 9 days (IQR 6-11). SD patients had a longer median length of stay (2 vs 1 day, p = 0.076. Follow-up rates were higher in AD at 1 year (65% vs 36%, p = 0.003). MI rates were 0% at 30- and 90-day and 0.9% at 1-year. Stroke rates were 0.9%, 0.9%, and 1.8% at 30-day, 90-day, and one year, with no difference between AD vs SD. 1-year mortality rates were 0.9% and 5.3% at 90-day and one year, without a difference by AD vs SD. Restenosis occurred in 4% of patients, with no difference between groups.

Conclusions

Carotid endarterectomy was associated with low perioperative rates of ipsilateral stroke, MI, and death. Despite a longer LOS, SD patients did not have significantly different outcomes or restenosis rates. While males had improved follow-up rates, there was no significant difference in outcomes by gender or race. These findings support favorable outcomes following CEA in both AD and SD.