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Cartoid Near Occlusion: Time to Re-think Endarectomy?

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Carotid endarterectomy is a safe and effective treatment for carotid near occlusion (CNO). Surgical intervention in CNO patients yields comparable outcomes to non-CNO patients, preventing neurological events.

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Area of Science:

  • Vascular Surgery
  • Neurology
  • Cardiovascular Medicine

Background:

  • Carotid near occlusion (CNO) treatment remains controversial, with ongoing debate regarding surgical revascularization.
  • Evaluating periprocedural complications, technical failure, and long-term outcomes is crucial for CNO patient management.

Purpose of the Study:

  • To assess the efficacy and safety of carotid endarterectomy (CEA) in patients with CNO compared to non-CNO patients.
  • To determine the impact of CEA on postoperative neurological complications and long-term results in both patient groups.

Main Methods:

  • Retrospective analysis of 152 patients undergoing isolated CEA between January 2018 and June 2020.
  • Patients were stratified into two groups: CNO (n=52) and non-CNO (n=100), excluding those with critical contralateral lesions.
  • Comparison focused on postoperative transient ischemic attack (TIA), ipsilateral ischemic stroke, and mortality rates.

Main Results:

  • CEA demonstrated high procedural success rates: 100% in the CNO group and 99% in the non-CNO group.
  • No statistically significant differences were observed in postoperative neurological complications or primary endpoints at 12-month follow-up between the CNO and non-CNO groups.
  • Mortality rates were low and comparable: 1.9% in the CNO group versus 3% in the non-CNO group.

Conclusions:

  • Carotid endarterectomy is a safe, feasible, and advantageous procedure for selected CNO patients.
  • Surgical treatment for CNO patients yields outcomes comparable to those in non-CNO patients.
  • A surgical approach is recommended for CNO patients to prevent potential neurological events.