Impact of Carotid Artery Angioplasty in Symptomatic vs. Asymptomatic Carotid Artery Disease

Objectives: To compare the procedural success as well as periprocedural complications and short-term clinical outcomes on CAS in symptomatic versus asymptomatic patients who have severe carotid artery stenosis. Methods: This study is an observational, single center, prospective cohort study of 250 patients with a mean age of 74±7.2 years who underwent CAS from 2018 to 2024 in a tertiary cardiovascular center, classified into two groups: symptomatic(n=146), and asymptomatic(n=104). Technical success, early complications within thirty days, restenosis, late stroke, and six-month event-free survival were analyzed. Results: There was technical success achieved in about 98.3% of the population under study (n = 246), while major stroke of early onset was recorded at about 1.6%. Minor stroke/TIA was recorded at about 4.8% percent with a higher percentage among the symptomatic. There were no myocardial infarctions. More than 50% restenosis at 6 months follow-up was noted in 6.8% with an event-free survival of 90%, better for asymptomatic patients (96% vs. 85.6%). Conclusions: CAS produces a safe and efficient method of revascularization in the management of symptomatic and asymptomatic carotid artery stenoses with high technical success and low complication rates. Short-term results were better in asymptomatic patients; therefore, patient selection and risk stratification are very important when making decisions clinically.