Carotid Artery Endarterectomy Research Articles

Treatment of Symptomatic Carotid Webs: A Single Center Review

IntroductionCarotid webs are abnormal thin shelf-like or flap-like tissue in the carotid bulb (proximal internal carotid artery). Rarely are carotid webs detected prior to symptoms since routine carotid artery surveillance is not performed in younger individuals without traditional risk factors for carotid disease. The cause and natural history remain unknown. In general, they are not common, but should be considered in the differential diagnosis of a patient who presents with ischemic neurologic symptoms. The web can create a flow disturbance, potentiating local thrombus formation, which can embolize producing resulting in cerebral ischemia. Current treatment is to reduce thrombus formation (antithrombotics and/or anticoagulation) or to alter the flow disturbance caused by the web (surgical removal or stent). MethodsWe retrospectively identified all patients presenting with acute ischemic stroke to our Comprehensive Stroke Center that were diagnosed with carotid web from January 2020 to December 2023. Patient demographics, presentation, hospital course including treatment and complications were collected and reported. ResultsFifteen patients presented with carotid web and stroke from 2020-2023 and 13 underwent carotid artery stenting or endarterectomy with no periprocedural complications. Most (40%) carotid webs were not primarily identified by the initial radiology interpretation. DiscussionWe discuss our experience of carotid web and its management as well as review of the current literature.

Letter to Editor Regarding “Comparison of Perioperative Safety of Carotid Artery Stenting and Endarterectomy in the Treatment of Carotid Artery Stenosis: A Meta-Analysis of Randomized Controlled Trials”

Letter to Editor Regarding “Comparison of Perioperative Safety of Carotid Artery Stenting and Endarterectomy in the Treatment of Carotid Artery Stenosis: A Meta-Analysis of Randomized Controlled Trials”

Our experiences with carotid artery endarterectomy operations

Aims: In this retrospective study, we aimed to presentour experiences with patients undergoing carotid endarterectomy (CEA) operations. Methods: Between January 2011 and January 2021, a total of 88 patients (27 female, 61 male, mean age; 68.9 ± 8.7 and 41-88 years old) who underwent CEA were included in the study.Patients' files were reviewed.Bilateral CEA was performed in 2 of the patients. The complaints and demographic characteristics of the patients are shown in Table 1 and Table 2, respectively. Coronary artery bypass grafting (CABG) was also performed in 10 (8 of them simultaneously and 2 of them 1 month later)of the patients. In one of these simultaneously operated patients, aortic valve replacement was performed in addition to CEA and CABG. On the other hand, the operation was terminated due to the development of intraoperative sudden cardiac arrest in 2 patients. Results: Polytetrafluoroethylene patch, biological patch, Dacron patch, and great saphenous vein patch were used in 1, 1, 3,and 40 patients, respectively, while the CEA site was primarily closed in 43 patients.Characteristic features ofthe CEA operations are shown in Table 3. Also, complications of CEA surgery are shown in Table 4.In-hospital mortality was detected in 3 patients. Conclusion: The early results of our CEA operations are in line with the literature.

Carotid Artery Stenting Versus Carotid Artery Endarterectomy in Asymptomatic Severe Carotid Stenosis: An Updated Meta-Analysis.

Carotid artery stenting (CAS) and carotid artery endarterectomy (CEA) are revascularization options for the management of severe carotid disease in asymptomatic patients. We aimed to compare the peri-procedural outcomes of the two modalities. A systematic review of the databases PUBMED, EBSCO, and Cochrane Library was performed. All the studies that reported periprocedural outcomes (within 30 days) in asymptomatic carotid stenosis patients were included in the meta-analysis. Random effects models with inverse-variance weighting were used to estimate pooled risk ratios (RRs) to compare the outcomes. Fifteen studies (including seven randomized controlled trials) met the inclusion criteria. A total of 15251 patients were included, out of which 6419 (42%) underwent CAS and 8832 (57.9%) underwent CEA. There was no statistical difference in the primary composite outcome of death/stroke/myocardial infarction (MI) (RR 1.02, 95% CI [0.69-1.51], p 0.93). No difference was found in the secondary outcome of all-cause mortality. CAS was associated with a slightly lower risk of MI and cranial nerve palsy. CAS was associated with a slightly higher risk of stroke with no difference in the occurrence of disabling stroke or ipsilateral stroke. In general terms, the study confirms equipoise in the two treatment strategies with a higher risk of MI and cranial nerve palsy with CEA and a higher risk of non-disabling stroke with CAS.

Carotid artery stenting and endarterectomy surgery techniques: A 30‑year time‑lapse.

Carotid endarterectomy or carotid artery stenting (CAS), are the most important axes in carotid artery interventional management. A bibliometric analysis permits an easier access to the current literature trends and information to design future studies. The aim of the present study was to identify the knowledge routes on CAS and examine the research front on the topic. The search was interpreted in Scopus, from 1994 to 2023, and included only original articles and reviews. The BibTex format was used to download all citation and bibliographic data. The present analysis was conducted in two parts, a descriptive one and a network extraction process. Between 1994 and 2023, 34,503 references and 7,758 authors were recorded. The annual growth rate was 21.64%. The CAVATAS trial was the most cited article. As regards word trends, since 2017, trans-carotid stenting, risk factors and plaque characteristics are highlighted. CAS remains an area of high interest with a publication growth rate of >20% per year. As numerous questions remain to be answered, the need to determine the role of CAS may drive further research.

Simulation-Based Training for Carotid Artery Endarterectomy and Carotid Artery Stenting are Effective but Lack Standardization: A Systematic Review

Simulation-Based Training for Carotid Artery Endarterectomy and Carotid Artery Stenting are Effective but Lack Standardization: A Systematic Review

Comparison of Perioperative Safety of Carotid Artery Stenting and Endarterectomy in the Treatment of Carotid Artery Stenosis: A Meta-Analysis of Randomized Controlled Trials

Current management guidelines for the treatment of carotid stenosis are controversial. We performed this meta-analysis to evaluate the perioperative safety of carotid artery stenting (CAS) and endarterectomy. We systematically searched EMBASE, PubMed, Web of Science, and the Cochrane Library from inception to November 10, 2022, for randomized controlled trials that compared CAS with carotid endarterectomy (CEA) among patients with carotid stenosis. The analyzed outcomes mainly included stroke, death, myocardial infarction (MI), cranial nerve palsy, the cumulative incidence of mortality, stroke, or MI and the cumulative incidence of death or stroke in the perioperative periods. The risk ratio (RR) and 95% confidence interval (95% CI) were calculated and pooled. Subgroup analyses were based on whether patients were symptomatic or asymptomatic. We assessed the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. Seventeen randomized controlled trials with 12,277 participants (6514 and 5763 in the CAS and CEA groups, respectively) were included. Pooled analysis demonstrated that compared with CEA, CAS was associated with decreased risks of perioperative MI (RR=0.47, 95% CI=0.29∼0.77) and perioperative cranial nerve palsy (RR=0.02, 95% CI=0.01∼0.06) but higher risks of perioperative stroke (RR=1.48, 95% CI=1.18∼1.87) and cumulative incidence of death or stroke (RR=1.52, 95% CI=1.20∼1.93). The perioperative safety was equivalent between CAS and CEA. However, CEA may be preferred when considering both procedural safety and long-term efficacy in preventing recurrent stroke.

Influence of Carotid Endarterectomy on Choroidal Perfusion: The INFLATE Study

Patients with clinically significant carotid artery stenosis (CAS) undergoing carotid artery endarterectomy (CEA) were imaged with swept-source OCT angiography (SS-OCTA) imaging protocol to determine if there were changes in choroidal blood flow after surgery. Prospective observational study. Patients with clinically significant CAS undergoing unilateral CEA. All participants underwent SS-OCTA imaging using a 6× 6-mm scan pattern on both eyes before CEA and within 1 week after CEA. Previously validated automated algorithms were used to measure the mean choroidal thickness (MCT) and choroidal vascular index (CVI) within 2.5-mm and 5-mm circles centered on the fovea. Multivariable regression analysis was conducted to evaluate the impact of various baseline factors including age, mean arterial blood pressure, and degree of stenosis, on both baseline of MCT and CVI, and the changes in MCT and CVI. Changes in MCT and CVI. One hundred sixteen eyes from 60 patients with a mean age of 71.57 ± 7.37 years were involved in the study. At baseline, MCT in both the 2.5-mm and 5-mm circles was significantly thinner on the surgical side compared with the nonsurgical side (P= 0.03), while no significant differences were seen in the CVI at baseline between the 2 sides (2.5-mm circle: P= 0.24; 5-mm circle: P= 0.09). Within 1 week after CEA, there were significant increases in the MCT on the surgical side, as compared with the nonsurgical side, in both the 2.5-mm (P < 0.001) and the 5-mm (P < 0.001) circles. No significant change in mean CVI was noted before and after CEA on the surgical side versus the nonsurgical side (2.5-mm circle: P= 0.30; 5-mm circle: P= 0.97). Multivariable regression analysis revealed that baseline MCT before CEA significantly decreased with age on both the surgical (P < 0.001) and nonsurgical sides (P= 0.003) while the changes in MCT and CVI after CEA were not associated with age, mean arterial blood pressure, or degree of stenosis. A rapid and significant increase in MCT was observed on the ipsilateral side of CEA, suggesting an improvement in choroidal perfusion within 1 week after surgery. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Evaluation of the efficiency of endarterectomy from the external carotid artery in patients with internal carotid artery occlusion

Objective. To assess the effect of external carotid artery (ECA) endarterectomy on regional cerebral blood flow, cognitive function, and quality of life in patients with ICA occlusion.Materials and Methods. From 2019 to 2020 year, 14 operations were performed on patients with ICA occlusion and hemodynamically significant ECA lesion. 14 patients, 12 men (85.7 %) and 2 women (14.3 %) underwent resection of the ICA, endarterectomy of the common carotid artery (CCA), and ECA. All patients had a history of stroke of 7±5.7 months. Neurological deficit according to the Rankin scale was 2 points in 11 patients (78.6 %) and 3 points in 3 patients (21.4 %). The mean age was 62.8±11.6 years. The preoperative period included ultrasound duplex scanning and computed tomography with the contrast of the brachiocephalic arteries. Single-photon emission computed tomography was used to assess cerebral blood flow before and after surgery. Cognitive status and quality of life were assessed by questionnaire survey.Results. In the early postoperative period, there were no registered strokes. A decrease in hypoperfusion foci and an increase of cerebral blood flow by an average of 10,33 ± 6,70 ml/min/100 g were observed in 13 patients (92,8 %). The Montreal Cognitive Deficit Scale score was 3,92±3,6. Improvement of quality of life according to the Short Form-36 questionnaire was 9.27±14.75.Conclusion. Endarterectomy of the external carotid artery at the internal carotid artery occlusion leads to a significant increase of regional cerebral blood flow in symptomatic patients, which in turn correlates with the regression of neurological deficit and improvement of quality of life. Continued work in this area will be a detailed analysis of the results of the treatment of patients with occlusion of the internal carotid artery for the period from 2018 to 2022 year.

A Scoping Review of Simulation-Based Training Paradigms for Carotid Artery Endarterectomy and Carotid Artery Stenting

Surgical simulation has come to the forefront to enhance the training of residents. The aim of our scoping review is to analyze the available simulation-based carotid revascularization techniques, including carotid endarterectomy (CEA) and carotid artery stenting (CAS) and suggest critical steps for evaluating competency in a standardized fashion. A scoping review of all reports on simulation-based carotid revascularization techniques including CEA and CAS was performed in PubMed/MEDLINE, Scopus, Embase, Cochrane, Science Citation Index Expanded, Emerging Sources Citation Index, and Epistemonikos databases. Data were collected according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The English language literature was searched from January 1, 2000 to January 9, 2022. The outcomes evaluated included measures of assessment of operator performance. Five CEA and 11 CAS manuscripts were included in this review. The methods of assessments employed by these studies to judge performance were comparable. The 5 CEA studies sought to validate and demonstrate improved performance with training or distinguish surgeons by their experience level, either through assessing operative performance or end-product results. The 11 CAS studies used 1 of 2 types of commercial simulators and focused on determining the efficacy of simulators as teaching tools. By examining the steps of the procedure associated with preventable perioperative complications, it provides a reasonable framework for determining which elements of the procedure should be emphasized most. Furthermore, using potential errors as a basis for assessment of competency could reliably distinguish operators based on level of experience. Competency-based simulation training is becoming more relevant as our surgical training paradigm shifts with the increased scrutiny within training programs of work-hour regulations and the need to develop a curriculum to assess our trainees' ability to perform specific operations competently during their stipulated training period. Our review has given us an insight into the current efforts in this space regarding 2 specific procedures that are key for all vascular surgeons to master. Although many competency-based modules are available, there is a lack of standardization in the grading/rating system of what surgeons consider vital steps of each procedure to assess these simulation-based modules. Therefore, the next steps of curriculum development should be based on standardization efforts for the different protocols available.

Early postoperative outcome after carotid artery endarterectomy with bifurcation advancement.

Background: The aim of this study is to review the single center experience in surgical treatment of carotid artery disease (CAD) using bifurcation advancement carotid endarterectomy (BA-CEA) and compare the in-hospital outcome with one of the largest nationwide carotid endarterectomy (CEA) databases worldwide, the German statutory quality assurance database (GD). Patients and methods: Data of BA-CEA procedures in the period of 2006-2015 were analyzed retrospectively. The primary endpoint was defined as combined stroke and death rate. Secondarily, isolated stroke, TIA, patient death, myocardial infarction, major neck hematoma and cranial nerve injuries were analyzed. Symptomatic and asymptomatic CAD patients were divided into two subgroups. The results were compared to extracted published data from the German database (GD). Results: Of 239 included BA-CEA procedures188 (78.7%) procedures were carried out in patients with symptomatic carotid artery stenosis. The overall perioperative combined stroke and death rate after BA-CEA was 2.5%.Five (2.1%) patients suffered from a stroke (one minor and four major strokes), of which two hemorrhagic strokes ended fatally. Overall, four (1.7%) patients died perioperatively. The combined stroke and death rate was higher in the symptomatic subgroup (3.2%; 0% in the asymptomatic group). No significant differences were found between the results of BA-CEA and the German database (n=142'074) for combined stroke and death rates and isolated stroke. Significant differences were found among the overall mortality rate (BA-CEA: 1.7% vs. GD: 0.6, p=0.04). The risk of postoperative cranial nerve injuries was also significantly higher after BA-CEA overall (BA-CEA: 5.0% vs. GD: 1.2%, p=<0.0001), in symptomatic CAD patients (BA-CEA: 4.8% vs. GD: 1.2%, p=<0.0001) and in asymptomatic CAD patients (BA-CEA: 5.9% vs. GD: 1.3%, p=0.01). Conclusions: CEA with bifurcation advancement provides comparable perioperative results, focusing on combined stroke and mortality, but seems to have some technical drawbacks, which may lead to more frequent local neurological complications.

Optimal cutoff value of carotid stump pressure for determining the need for a carotid shunt in carotid artery endarterectomy.

This study was conducted to identify the diagnostic value of carotid stump pressure for determining the need for a carotid artery shunt in patients undergoing carotid artery endarterectomy. Carotid stump pressure was prospectively measured in all carotid artery endarterectomies performed under local anesthesia between January 2020 and April 2022. The shunt was selectively used when neurological symptoms appeared after carotid cross-clamping. Carotid stump pressure was compared between patients who needed shunting and those who did not. Demographic and clinical characteristics, hematological and biochemical parameters, and carotid stump pressure of the patients with and without shunts were statistically compared. To determine the optimal cutoff value and diagnostic performance of carotid stump pressure for identifying the patients who need a shunt, receiver operating characteristic analysis was performed. Overall, 102 patients (61 men and 41 women) who underwent carotid artery endarterectomy under local anesthesia were included, with an age range of 51-88years. A carotid artery shunt was used in 16 (8 men and 8 women) patients. The carotid stump pressure values of the patients with a shunt were lower than those without a shunt (median (min-max): 42 (20-55) vs 51 (20-104), p < 0.0006). In the receiver operating characteristic curve analysis performed to determine the need for a shunt, the optimal cutoff value of carotid stump pressure was ≤48mmHg, sensitivity was 93.8%, and specificity was 61.6% (area under the curve: 0.773, p < 0.0001). Carotid stump pressure has sufficient diagnostic power to determine the need for a shunt, but it cannot be used alone in the clinical setting. Instead, it can be used in combination with other neurological monitoring methods.

Inflammation and Wound Infection after Carotid Artery Endarterectomy and the Use of Biological Glue for Hemostasis

Inflammation and Wound Infection after Carotid Artery Endarterectomy and the Use of Biological Glue for Hemostasis

Does Modified Rankin Score (mRS) Matter? The Impact of Stroke Severity on Carotid Artery Endarterectomy (CEA) Outcomes

Carotid artery endarterectomy (CEA) is recommended to reduce stroke risk in patients following non-disabling ischaemic stroke (modified Rankin Score mRS<3). We reviewed CEA outcomes in patients after more devastating strokes (mRS≥3). An observational cohort study was performed, and data was collected from 1013 CEA cases over fifteen years. Patient demographics, co-morbidities and post-operative outcomes were compared between preoperative mRS<3 (Group one) and mRS≥3 (Group two). Statistical significance was determined by p<0.05. Ninety-one (9%) patients were mRS ≥ 3. There was no significant difference between age, gender, and operated side. Group two had significantly higher rates of diabetes and frailty. There was no significant difference in anaesthetic type. Group two spent longer in High Dependency. Return to theatre and post-operative complications were similar. Incidence of perioperative stroke, mortality and readmission rates were not significant at 30 days post-operation between the two groups. Patients with a higher mRS have more pre-operative co-morbidities but short-term perioperative complication rate is not significantly different. Patient selection should be undertaken with care.

Morphometric Study and Branching Patterns of External Carotid Artery Using Computed Tomography Angiography Among the South Indian Population: A Retrospective Study.

The prime source of vascularization to the head and neck region is through the carotid arteries. The terminal branches of common carotid arteries, such asexternal carotid artery (ECA) and internal carotid artery (ICA), and their branches are crucial due to the wide area of distribution and variations in their branching pattern. The branching pattern and morphometry are essential for surgeons in the planning and execution of head and neck surgeries. Therefore, this study was conducted to observe the branching patterns of ECA and analyze them morphometrically. This retrospective study includes 100 CT images, inclusive of 32 females and 68 males. The branching pattern and luminal diameter of CCA and ECA were measured and analyzed statistically. The luminal diameter of CCA in males were as follows: 7.4 ± 1.01 (R), 7.1 ± 0.8 (L), and in females: 7.3 ± 0.9 (R), 7 ± 0.9mm (L); and the luminal diameter of ECA in males: 5.2 ± 1.0mm (R), 5.2 ± 0.9mm (L), and in females: 5.0 ± 0.9mm (R), 5.1 ± 1.0mm (L). The level of the carotid bifurcation and ECA branching pattern was observed, and variations were commonly seen in the superior thyroid artery (STA), lingual artery (LA), and facial artery (FA). Conclusion: The findings of the present study with regard to the external carotid artery and its branching pattern correlate with previous studies. The most common variations were observed in the superior thyroid and lingual and facial arteries. Knowledge about the morphology and branching pattern of the carotid artery is essential for procedures such as intra-arterial chemotherapy, carotid artery stenting, endarterectomy, and extra-intra cranial bypass revascularization procedure where it is harvested as a donor's vessel.

Carotid artery bypass versus endarterectomy as an alternative treatment of carotid artery stenosis: A propensity score matching analysis

ObjectivesThe main focus of this study is to evaluate the reliability and durability of saphenous vein bypass grafting from common carotid artery to internal carotid artery (CBG) asan alternative treatment of patients with carotid artery stenosis. Methods459 patients with carotid artery stenosis underwent initial carotid endarterectomy (CEA) or CBG between 2009 and 2019. Propensity score matching was performed, and outcomes of two different surgical procedures were analyzed. ResultsOutcomes of the 142 pairs of matched patients were investigated. There were no significant differences in the preoperative characteristics of these matched groups. Overall mean time of follow-up was 91.364 ± 3.265 months. Mortality rate during the follow-up period was 18.309% (26 patients) in the CEA group, and 11.971% (17 patients) in the CBG group. Stroke was encountered in 8 patients in the CEA group (5.63%), and 3 patients in the CBG group (2.11%) during follow-up. Restenosis was detected in 11 patients in the CEA group (7.75%), and 3 patients in the CBG group (3.52%) during follow-up. There were no significant differences in the survival, stroke – free survival, and restenosis - free survival distributions of both groups. ConclusionsIn carotid artery stenosis, it is reasonable to consider CBG as an alternative surgical option when adequate disease-free inflow (common carotid artery) and outflow (distal internal carotid artery) segments are present.

Long-term results after simultaneous carotid and coronary revascularisation.

The revascularisation strategy for concomitant carotid and coronary disease is unknown. Simultaneous or stage coronary artery stenting and carotid endarterectomy are the most common revascularisation approach in the CABG population. This study aimed to evaluate long-term results after simultaneous carotid artery stenting or carotid endarterectomy in patients who underwent coronary artery bypass surgery. This is a prospective cohort non-randomised single-institution study. During the period from 2012 to 2015, sixty consecutive patients (65.9 ± 7.41 mean) underwent simultaneous carotid artery stenting and coronary artery bypass surgery (n = 30) or simultaneous carotid endarterectomy and coronary artery bypass surgery (n = 30). The primary endpoints were short- and long-term rates of adverse events (transient ischemic attack, stroke, myocardial infarction, and death). The mean follow-up was 62.05 ± 11.12 months. In-hospital mortality was insignificantly higher in the carotid endarterectomy, and coronary artery bypass surgery group (6.6% vs. 0%), the rate of stroke and myocardial infarction was similar (13.3% and 0% in the carotid endarterectomy and coronary artery bypass surgery group vs. 6.6% and 3.3% in the carotid artery stenting and coronary artery bypass surgery group, respectively). The intensive care unit readmission was significantly higher in the surgical revascularisation approach; it was an independent predictor of hospital mortality. The overall mortality during the follow-up period was 14.28% in both groups. Freedom of the composite adverse outcomes (stroke, myocardial infarction, and death) was 78.55%. Comparing two revascularisation strategies is not straightforward due to different anatomical indications for carotid artery stenting and endarterectomy. We consider that each technique has an essential role in carotid revascularisation. Good selection of patients, according to indications, contributes to satisfactory short- and long-term results.

Prognostic values of the C-reactive protein to albumin ratio and prognostic nutritional index in carotid endarterectomy patients.

C-reactive protein to albumin ratio (CAR) and prognostic nutritional index (PNI) are novel parameters with proven prognostic importance in the postoperative outcomes of coronary and peripheral vascular diseases. In this study, we aimed to evaluate the ability of CAR and PNI to predict major cardiac and cerebrovascular events (MACCE) during the postoperative period of Carotid artery endarterectomy (CEA). A total of 505 carotid endarterectomy patients were retrospectively evaluated. Of 505 patients, 23 patients who died and who experienced myocardial infarction or major neurologic complication in the first 30days after the operation were included in MACCE group (Group 1). The remaining 482 patients were included in Group 2. Receiver operating characteristics (ROC) curve analysis was used to evaluate preoperative serum albumin value, lymphocytes count, PNI, and CAR to predict the MACCE. The DeLong test was used to compare the area below the curve (AUC) with each of these parameters. CAR (2.48 ± 1.82 and 1.64 ± 1.37) and CRP (9.98 ± 7.42 and 6.81 ± 5.70) values are statistically higher in Group 1 than in Group 2. PNI (41.59 ± 3.11 and 43.54 ± 4.20) and albumin (40.43 ± 3.15 and 42.35 ± 4.15) values were significantly lower in Group 1 than in Group 2. The accuracy of albumin (AUC: 0.669) in the prediction of MACCE was found to be the highest among CAR (AUC: 0.631), PNI (AUC:0.667), and CRP (AUC:0.631). Preoperative nutritional and inflammatory status is significantly associated with post-operative outcomes. PNI and CAR can be used for preoperative evaluation, as CEA is recommended for patients who have low possibility of having postoperative major adverse events.

The relationship between platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio and prognosis in carotid artery endarterectomy

The relationship between platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio and prognosis in carotid artery endarterectomy

Effect of Reconstructive Procedures of the Extracranial Segment of the Carotid Arteries on Damage to the Blood-Brain Barrier.

Introduction: Endarterectomy and angioplasty of the internal carotid artery are surgical measures for the prevention of ischemic stroke. Perioperative complications are caused by concomitant embolism and reperfusion syndrome leading to damage of the blood–brain barrier. Methods: The study included 88 patients divided into two groups, depending on the surgical technique used: internal carotid artery endarterectomy (CEA), 66 patients, and percutaneous carotid angioplasty and stenting (CAS), 22 patients. Blood was drawn 24 h before surgery, as well as 8, 24, and 48 h post-surgery. The assessment of damage to the blood–brain barrier was based on the evaluation of the concentration of claudin-1 and occludin, aquaporin-4, the measurements of the activity of metalloproteinase-2 (MMP-2) and -9 (MMP-9), and the assessment of central nervous system damage, measured by changes in the blood S100β protein concentration. Results: A significant increase in the concentration of the blood–brain barrier damage markers and increased MMP-2 and MMP-9 activity were found in patient blood. The degree of damage to the blood–brain barrier was higher in the CEA group. Conclusions: The authors’ own research has indicated that revascularization of the internal carotid artery may lead to damage to the central nervous system secondary to damage to the blood–brain barrier.