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

This study aimed to explore how clinical and radiological profiles of patients undergoing carotid endarterectomy (CEA) have changed over the past 40 years.

We included our three Japanese case series of CEA in the late 1980s (n = 73), the 2000s (n = 142), and the 2010s (n = 108). We precisely compared the patients' demographics, clinical features, radiological findings, and short- and long-term outcomes among the three cohorts. CEA was performed with general anesthesia, routine use of an internal shunt tube, intraoperative monitoring using somatosensory evoked potential or near-infrared spectroscopy, precise and bloodless manipulation using an operating microscope, and primary closure.

The mean age of patients significantly increased from 55 years to 73.6 years during these 40 years (P < 0.01). The incidence of patients with more than 90% stenosis significantly decreased from 54.9% to 24.5% (P < 0.01), while the incidence of patients with mild stenosis significantly increased from 4.2% to 29.4% between the 2000s and 2010s (P < 0.01). The incidence of patients with impaired cerebral hemodynamics significantly decreased from 41% to 21% (P < 0.01). The frequency of transient ischemic attack markedly decreased from 33% to 10%, while the frequency of ischemic stroke significantly increased from 48% to 80% (P < 0.01). Annual risk of ipsilateral stroke during follow-up periods decreased from 2.1% to 0.2% over the time.

This study demonstrates significant differences in the demographics, radiological findings, and clinical results among patients undergoing CEA over 40 years, probably because of the patient's lifestyle, advances in imaging techniques, understanding of the pathophysiology, advances in medical therapy, selection criteria of candidates for CEA, and treatment guidelines.