Key result
Carotid endarterectomy yields similar low 1-year event rates in symptomatic and asymptomatic patients.
Why the study?
The role of carotid revascularization in asymptomatic and symptomatic carotid disease continues to evolve with advances in medical therapy, surgical techniques, and cost considerations.
Does symptomatic presentation compared with asymptomatic presentation affect 30-day, 90-day, and 1-year rates of ipsilateral stroke, myocardial infarction, and death in patients undergoing carotid endarterectomy?
Cohort (n=113)
No
Does symptomatic presentation compared with asymptomatic presentation affect 30-day, 90-day, and 1-year rates of ipsilateral stroke, myocardial infarction, and death in patients undergoing carotid endarterectomy?
Carotid endarterectomy demonstrates low perioperative and 1-year rates of stroke, myocardial infarction, and mortality, with comparable outcomes between symptomatic and asymptomatic patients.
Answers are grounded in this paper and cite their sources.
Adds single-center CEA safety data across symptom status; leaves open prospective trials versus modern medical therapy.
BACKGROUND: While carotid revascularization reduces stroke risk in both asymptomatic (AD) and symptomatic (SD) carotid disease, its role continues to evolve with advances in medical therapy, surgical techniques, and cost considerations. METHODS: This retrospective study reviews outcomes of patients undergoing revascularization at a level one stroke center between 2019 and 2024. Primary endpoints were ipsilateral stroke, myocardial infarction, and death at 30-day, 90-day, and 1-year. Secondary endpoints include restenosis rates. RESULTS: 113 patients underwent 127 carotid endarterectomies. Sixty-four percent presented with SD, with a median time to intervention of 9 days (IQR 6-11). SD patients had a longer median length of stay (2 vs 1 day, p = 0.076. Follow-up rates were higher in AD at 1 year (65% vs 36%, p = 0.003). MI rates were 0% at 30- and 90-day and 0.9% at 1-year. Stroke rates were 0.9%, 0.9%, and 1.8% at 30-day, 90-day, and one year, with no difference between AD vs SD. 1-year mortality rates were 0.9% and 5.3% at 90-day and one year, without a difference by AD vs SD. Restenosis occurred in 4% of patients, with no difference between groups. CONCLUSIONS: Carotid endarterectomy was associated with low perioperative rates of ipsilateral stroke, MI, and death. Despite a longer LOS, SD patients did not have significantly different outcomes or restenosis rates. While males had improved follow-up rates, there was no significant difference in outcomes by gender or race. These findings support favorable outcomes following CEA in both AD and SD.
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Mohsin et al. (2026) conducted a cohort in Carotid artery disease (asymptomatic and symptomatic) (n=113). Symptomatic carotid disease presentation undergoing carotid endarterectomy vs. Asymptomatic carotid disease presentation undergoing carotid endarterectomy was evaluated on Ipsilateral stroke, myocardial infarction, and death at 30-day, 90-day, and 1-year. Carotid endarterectomy yielded low 1-year rates of stroke (1.8%), MI (0.9%), and mortality (5.3%), with no significant differences between symptomatic and asymptomatic patients.
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