Carotid Endarterectomy for Patients With Symptomatic Moderate (50% - 70%) Stenosis: Does the Procedure Warrant the Risk?

Purpose: Although patients with moderate (50-70%) stenosis in symptomatic carotid artery disease (CAD) were included in the NASCET study, many neurologists are still reluctant to refer patients for definitive therapy. In this study, we evaluate our results in patients undergoing carotid endarterectomy (CEA) for moderate and severe symptomatic carotid artery stenosis (CAS).
Methods: We reviewed data from our prospectively maintained vascular registry on patients undergoing symptomatic CEA over the past 20 years. Patients were stratified to the percent stenosis. Results were analyzed in regard to transient and permanent neurologic deficits and perioperative mortality.
Results: During this period, 2534 had CEA for symptomatic CAS; 428 moderate (50-70%), 1425 for 71- 90%, and 681 for >90% stenosis by duplex ultrasound. Risk factors were similar in all groups. Of those with moderate (50-70%) stenosis, 10 (2.4%) had severe permanent neurologic deficits, 8 (1.87%) transient neurologic deficits, and 5 (1.17%) died in the perioperative period. Those with more severe (71-90%) stenoses, 20 (1.4%) had permanent neurologic deficit, 20 (1.4%) transient neurologic deficit, and 13 (.91%) died in the perioperative period. Those with severe (91-100%) stenoses or occlusion, 9 (1.32%) had permanent neurologic deficit, 8 (1.17%) transient neurologic deficit and 6 (.88%) died in the perioperative period. These were not statistically significant.
Conclusion: Patients presenting with moderate and severe CAS and symptomatic CAD can be treated safely with minimal stroke mortality despite significant comorbidity. Results parallel those of more significant disease and are improved over the natural history of patients presenting with symptomatic CAS.