Carotid Near-Occlusion: Surgical or Conservative Management? Retrospective Multicenter Study

Area of Science:

• Vascular Surgery
• Neurology
• Cardiology

Background:

• Carotid near-occlusion (CNO) involves severe internal carotid artery stenosis (>90%).
• CNO is subcategorized by distal lumen diameter: <2 mm (full collapse) or >2 mm (no full collapse).
• Revascularization decisions for CNO remain debated.

Purpose of the Study:

• To analyze perioperative and follow-up complication rates in CNO patients.
• To compare outcomes between CNO with and without distal lumen full collapse.
• To inform revascularization strategies for CNO.

Main Methods:

• Multicenter retrospective study of 67 CNO patients undergoing carotid endarterectomy.
• Patients divided into two groups: lumen diameter <2 mm (n=28) and >2 mm (n=39).
• Outcomes assessed: perioperative neurological/cardiac events, restenosis, and occlusion.

Main Results:

• The <2 mm lumen group had 10.7% perioperative events (stroke, MI) and 7.1% follow-up events (occlusion, restenosis).
• The >2 mm lumen group had zero perioperative or follow-up events.
• Both groups were comparable in risk factors, morphology, and medical treatment.

Conclusions:

• Distal lumen collapse in CNO significantly impacts perioperative and follow-up complication rates.
• Carotid endarterectomy appears safer in CNO patients without distal lumen collapse.
• Findings support selective surgical intervention for CNO based on lumen status.