Clinical and radiological profie changes of patients undergoing carotid endarterectomy over 40 years

Satoshi Kuroda ¹, Daina Kashiawzaki ¹, Shusuke Yamamoto ¹

⁰Department of Neurosurgery, University of Toyama, Toyama, Japan.

Surgical Neurology International +

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April 10, 2025

View abstract on PubMed

Summary

Patient profiles for carotid endarterectomy (CEA) have shifted over 40 years, with older patients and less severe stenosis now common. Despite changes, the annual stroke risk post-CEA has significantly decreased.

Area Of Science

Vascular Surgery
Cerebrovascular Disease
Medical Technology Evolution

Background

Carotid endarterectomy (CEA) remains a critical procedure for preventing stroke.
Understanding temporal trends in patient characteristics and outcomes is vital for optimizing surgical practice.

Purpose Of The Study

To analyze changes in clinical and radiological profiles of patients undergoing CEA over a 40-year period.
To evaluate the evolution of patient demographics, disease severity, and procedural outcomes.

Main Methods

Retrospective analysis of three Japanese CEA case series from the late 1980s, 2000s, and 2010s.
Comparison of patient demographics, clinical presentations, radiological findings, and short- and long-term outcomes across cohorts.
Standardized surgical techniques including general anesthesia, shunt use, and intraoperative monitoring were employed.

Main Results

Patient age increased significantly (55 to 73.6 years).
Incidence of severe stenosis (>90%) decreased, while mild stenosis increased.
Cerebral hemodynamic impairment and transient ischemic attack frequency declined; ischemic stroke incidence rose.
Annual ipsilateral stroke risk post-CEA decreased from 2.1% to 0.2%.

Conclusions

Significant shifts in CEA patient profiles and outcomes over 40 years are evident.
These changes are likely influenced by lifestyle, imaging advancements, medical therapies, and evolving treatment guidelines.
The study highlights the dynamic nature of cerebrovascular disease management and CEA indications.

Keywords:

Carotid artery stenosis Carotid endarterectomy Change Long-term study Profile