The role of the carotid plaque fibrous cap in carotid-related stroke risk has been demonstrated in many studies. The aim of this study was to evaluate the relationship between the presence of a carotid plaque ulcer and the perioperative complication risk in a consecutive series/cohort of patients submitted to carotid endarterectomy (CEA) at our academic tertiary hospital. A retrospective review of a prospectively collected database on consecutive CEAs performed between January 2009 and December 2017 was performed. All patients with a carotid plaque ulcer (defined as a discontinuation in the carotid fibrous cap of >2 mm) at carotid duplex ultrasound were analyzed. Perioperative (30-day) complications considered for analysis were TIA, minor and major stroke, death, myocardial infarction, hemodynamic instability, cervical hematoma, and cranial nerve palsy. The prognostic value of plaque ulcer on the development of perioperative complications was assessed by odds ratio (OR) estimation. Among 964 CEAs, 158 were performed in symptomatic patients and 806 in asymptomatic patients. A carotid plaque ulcer was detected in 207 patients. Complications are reported in the Table. Plaque ulcer was significantly associated with preoperative presence of neurologic symptoms (OR, 1.51; 95% confidence interval [CI], 1.02-2.22; P = .03), but it was not significantly associated with an increase in total number of complications in the whole cohort (OR, 1.37; 95% CI, 0.86-2.17; P = .17) or in the symptomatic (OR, 1.47; 95% CI, 0.51-4.27; P = .46) or asymptomatic (OR, 1.36; 95% CI, 0.81-2.28; P = .23) groups. The presence of an ulcer was not able to predict the development of neurologic complications (transient ischemic attack, minor and major stroke, neurologic death) in symptomatic (OR, 1.30; 95% CI, 0.23-7.41; P = .75) and asymptomatic (OR, 1.50; 95% CI, 0.68-3.30; P = .30) patients. The presence of a carotid plaque ulcer is significantly associated with the presence of preoperative carotid-related neurologic symptoms, but it is not able to predict an increase in neurologic or total complications in a consecutive series of symptomatic and asymptomatic patients submitted to CEA.TableComplications occurred in 964 carotid endarterectomies (CEAs)Ulcerated plaque (207)Nonulcerated plaque (757)Total (964), No. (%)Neurologic death123 (0.31)Cardiac death112 (0.20)Major stroke2810 (1.03)Minor stroke4913 (1.34)TIA4913 (1.34)Asymptomatic CEA thrombosis033 (0.31)Cervical hematoma71825 (2.56)Hemodynamic instability347 (0.72)Cervical nerve palsy61723 (2.38)Myocardial infarction066 (0.62)Total2877105 (10.89)TIA, Transient ischemic attack. Open table in a new tab