What question did this study set out to answer?

This study aimed to verify compliance with ESVS quality standards for carotid endarterectomy regarding mortality and stroke rates.

April 13, 2026Open Access

Vascular Surgery

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Carotid artery disease (n=2500). Intervention: Carotid Endarterectomy vs. Symptomatic vs Asymptomatic status. Primary outcome: Combined endpoint of stroke and death within 30 days.

Key Result

Carotid endarterectomy achieved ESVS quality standards, with a 30-day stroke and death rate of 2.1% in asymptomatic patients and 5.5% in symptomatic patients.

Key Points

This study aimed to verify compliance with ESVS quality standards for carotid endarterectomy regarding mortality and stroke rates.
Retrospective data collection from patients undergoing carotid endarterectomy from 2014 to 2023.
Evaluation of CT and MRI data, reoperations, and 30-day mortality rates.
Data was analyzed with support from the IT department.
Postoperative reoperation rates were 2.3% for asymptomatic and 2.6% for symptomatic patients.
Overall mortality within 30 days was 0.5% for asymptomatic and 0.7% for symptomatic patients.
Stroke rates were 1.7% for asymptomatic and 4.8% for symptomatic patients, indicating a significantly higher risk for symptomatic patients.

Study Design

Type

Cohort (n=2,500)

Multicenter

PICO

Population

Carotid artery disease (n=2,500)

Intervention / Comparator

Carotid Endarterectomy vs Symptomatic vs Asymptomatic status

Primary Outcome

Combined endpoint of stroke and death within 30 days

Main Result

Absolute Event Rate: 5.5% vs 2.1%

Abstract

Background:The European Society of Vascular Surgery (ESVS) has published quality standards in its guidelines for Carotid Endarterectomy.The perioperative mortality and stroke rate should be below 3% for asymptomatic and below 6% for symptomatic patients.The objective of this study was to verify whether these thresholds could be maintained.Furthermore, the rate and the underlying reasons for reoperations were to be determined. Material and methods:Included were all patients who underwent surgery at the University Hospital Graz within the period from January 1 st , 2014, to December 31 st , 2023.A retrospective data collection was performed.To execute this analysis, all CT and MRI data, reoperations, and deaths within 30 days from the KAGES hospitals across the entire region of Styria were collected and evaluated with the help of the IT department. Results:A total of 2500 patients were evaluated, with an average age of 71.3 years.Gender distribution showed 67.6% (1689/2500) men and 32.4% (811/2500) women; 76.6% (1916/2500) were asymptomatic, while 23.4% (584/2500) were symptomatic.Sinus rhythm was present in 92.0%(2301/2500), with (intermittent) Atrial Fibrillation/Flutter (VHFA) in 7.9% (197/2500).Postoperatively, 2.3% (45/1871) of asymptomatic patients and 2.6% (15/569) of symptomatic patients required at least one reoperation.The causes were: 76.7% (46/60) bleeding, 21.7% (13/60) incorrect revascularization, and 1.7% (1/60) deep abscess.A total of 14 deaths occurred within 30 days: 0.5% (10/1906) for asymptomatic patients and 0.7% (4/580) for symptomatic patients.The stroke rate was 1.7% (32/1884) for asymptomatic patients and 4.8% (28/556) for symptomatic patients.The combined endpoint (stroke and death) occurred in 2.9% (73/2500) of patients.The risk for symptomatic patients was 5.5% (32/552), significantly higher than for asymptomatic patients at 2.1% (41/1875). Conclusion:The analysis confirms that the ESVS standards were achieved at the University Hospital Graz.There are ongoing discussions within the ESVS about whether the quality thresholds for carotid surgery should be lowered.Our data advocate for maintaining the established standards.

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