Contralateral disease progression after carotid endarterectomy

Area of Science:

• Vascular Surgery
• Neurology
• Cardiovascular Medicine

Background:

• Understanding the natural history of the contralateral carotid artery is essential after unilateral carotid endarterectomy (CE).
• Assessing the risk of new symptoms and disease progression in the non-operated carotid artery is critical for patient management.

Purpose of the Study:

• To investigate the incidence of new symptoms and disease progression in the contralateral carotid artery following unilateral CE.
• To identify predictors of adverse events in the contralateral artery.

Main Methods:

• A cohort of 127 patients undergoing unilateral CE was followed clinically and with serial duplex scanning.
• Patients were stratified based on initial contralateral stenosis severity (<50% vs. 50-99%).

Main Results:

• Over a mean follow-up of 44 months, 7% experienced new hemispheric events and 21% showed significant disease progression.
• Patients with initial contralateral stenosis ≥50% had a higher incidence of new symptoms (23% vs. 2%, p < 0.003) and underwent more subsequent CE procedures (p < 0.001).
• New symptoms did not consistently correlate with the degree of contralateral disease progression.

Conclusions:

• Significant contralateral carotid artery disease progression (21%) and new symptoms (7%) occur after unilateral CE.
• Initial contralateral stenosis >50% predicts future hemispheric symptoms, likely transient ischemic attacks.
• Serial clinical and duplex scanning is recommended for all patients post-unilateral CE due to observed progression across varying stenosis levels.