Carotid endarteretomy: A single vascular centre experience in Malaysia

Carotid artery stenosis remains one of the leading causes of major stroke. Carotid endarterectomy (CEA) has proven effective in preventing debilitating major stroke. However, the data on CEA in Malaysia is still lacking. University of Malaya Medical Centre, Kuala Lumpur, Malaysia first embarked on CEA since 2017. We are reporting the outcomes of CEA performed in our centre.

This was a retrospective case series of 20 patients who underwent CEA from the year 2017 until 2024. Patients having asymptomatic (≥60-99%) and symptomatic carotid artery stenosis (≥50-99%) were selected for the procedure. All patients received best medical treatment, which include antithrombotic medications, lipid lowering therapy, blood pressure management, diabetes mellitus management and lifestyle modifications especially smoking cessation. All the patients underwent CEA under general anaesthesia. Shunting was done routinely. Preoperative, intraoperative, and postoperative data were collected and evaluated. Mortality, myocardial infarction, stroke, postoperative bleeding, surgical site infection and cranial nerve injury at 30 days were the outcomes investigated. We also evaluated restenosis after CEA.

Most patients in our series were males 70% (n = 14) compared to 30% (n = 6) females. There were more symptomatic patients (n = 14) than asymptomatic patients (n = 6). There was one 30-day mortality among the symptomatic patients, while there was no 30-day mortality in the asymptomatic patients. The 30-day myocardial infarction was 5% (n = 1), which was the same symptomatic patient who died. In this cohort, only one patient had 30-day stroke (5%), which was a symptomatic patient. The patient recovered from the stroke after two weeks. Cranial nerve injuries happened in four patients (20%), where the commonest nerve injured was recurrent laryngeal nerve (n = 3). Only one patient had postoperative bleeding which did not need any reintervention. No surgical site infection was noted on all patients. Three patients developed restenosis, which was noted at two to six months post CEA. Two of the patients had symptomatic restenosis (more than 50% stenosis) which resulted in them being reoperated.

The uptake of CEA in Malaysia is still slow. By sharing the outcomes data, hopefully it will create awareness among medical practitioners on the importance of early referral for carotid artery stenosis. Long term outcomes are very much needed.