Outcome of carotid endarterectomy in patients with symptomatic carotid near occlusion with partial collapse

Abstract

Background Symptomatic carotid near occlusion with partial collapse (CNOPC) of the distal internal carotid artery (ICA) is an uncommon condition. Guidelines for its treatment have recommended conservative management, although surgery may be indicated for many patients. In this work, our goal was to examine the postoperative outcomes of CNOPC patients who had undergone carotid endarterectomy (CEA) for symptomatic disease. Methods Symptomatic CNOPC patients were identified in this single-center retrospective study from January 2019 to February 2022. Patients’ demographics, comorbidities, and CEA indications were gathered. At 30 days and 1 year after surgery, postoperative complications including stroke and death, hospital stay, and operational details were evaluated. Results In the 3-year study period, 128 CEAs were done, and 21 (16.4%) patients had CNOPC. Males were 15 (71.4%) with no sex difference in comorbidities except a significantly higher IHD in men, P less than 0.01. The mean ipsilateral to contralateral distal ICA luminal narrowing ratio was 34.1%. All patients had carotid patches. General anesthesia was associated with more shunt usage, P less than 0.05. High carotid bifurcation lengthened CEA time (P<0.05), but neither anesthetic type, nor the use of a shunt or patch did. At 30-day post CEA, there was only 1 (4.7%) recorded cerebrovascular event (CVA), no mortality, and no carotid restenosis or occlusion was found. At 1-year, no new CVA were reported but 1 (4.7%) fatality was recorded. Conclusion Carotid endarterectomy for patients with carotid near occlusion and partial distal collapse is safe and may be considered despite marginally higher procedural risks than patients with low-to-moderate risk anatomy.