Key result
Non-stroke CV events account for ~47% of late deaths after successful carotid endarterectomy, a declining proportion.
Why the study?
Carotid endarterectomy reduces stroke risk, but knowledge of the eventual causes of death was needed to help direct late post-CEA medical management.
What are the late causes of death following successful carotid endarterectomy?
Meta-Analysis
What are the late causes of death following successful carotid endarterectomy?
Following successful carotid endarterectomy, almost half of late deaths are due to non-stroke cardiovascular causes, whereas only 6.3% are stroke-related, suggesting a need to optimize general cardiovascular risk management.
Answers are grounded in this paper and cite their sources.
Reinforces cardiovascular risk optimization after carotid endarterectomy; extends evidence that non-stroke causes drive most late deaths despite recent decline.
INTRODUCTION: Carotid endarterectomy (CEA) reduces the risk of stroke. Knowledge of the eventual causes of death would assist in directing late post-CEA drug management. This review determines the causes of death and assesses whether this has changed over time and is influenced by CEA indications or preoperative coronary artery disease status. METHODS: Using PRISMA guidelines, the PROSPERO registered review identified only randomised controlled studies where the cause of late post-CEA death was reported by interrogating the PubMed and Cochrane databases. Titles and abstracts were reviewed, and publication bias was assessed once inappropriate studies had been removed. From the extracted data, a proportional meta-analysis of the non-stroke cardiovascular, stroke and cancer-related deaths was undertaken. A random effect model was used to pool proportions. For each, linear regression analysis determined the effect of changes in the proportion of deaths over time, symptomatic CEA indications, and preoperative coronary artery disease status. RESULTS: From 3838 publications between 1965 and 2025, 27 studies provided information on the late cause of death. 47.1 % (95 % CI 42.2 to 52.0) of deaths were non-stroke cardiovascular-related. This proportion has decreased in more recent publications (r = 0.61, p < 0.001). 6.3 % (95 % CI 4.5 to 8.4) of late deaths were stroke-related, which did not alter over time. 17.5 % (95 % CI 13.7 to 21.7) of late deaths were cancer-related. This proportion has increased with time (r = 0.59 p < 0.001). The indications for CEA or the preoperative coronary artery disease status did not influence the proportion of deaths. CONCLUSIONS: Post-CEA, almost half die from cardiovascular causes. A reduction in this proportion may indicate an improvement in treatment. The 6 % post-CEA stroke-related death rate is low compared to the overall proportion of recurrent fatal strokes and may indicate the success of CEA. Further outcome improvements can be achieved by focusing on general cardiovascular treatments rather than stroke-specific ones.
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Baker et al. (2025) conducted a meta-analysis in Successful carotid endarterectomy (CEA). Carotid endarterectomy (CEA) was evaluated on Proportion of non-stroke cardiovascular-related deaths (95% CI 42.2 to 52.0). Following successful carotid endarterectomy, 47.1% (95% CI 42.2-52.0) of late deaths were non-stroke cardiovascular-related, a proportion that has decreased in more recent publications (p<0.001).
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