IP04 - Early and Long-Term Outcomes of Carotid Endarterectomy in Patients with Carotid Near-Occlusion Versus Preocclusive Carotid Stenosis

Objectives: The role of carotid endarterectomy (CEA) in carotid near-occlusion (CNO) remains debated, and comparative outcome data with preocclusive carotid stenosis are limited. This study retrospective compares perioperative and long-term results of CEA in these two high-grade carotid disease subsets.

Methods: From January 2014 to September 2025, 1,775 consecutive CEAs were prospectively recorded at a single center. A retrospective analysis identified 81 procedures performed for CNO (Group 1) and 144 for preocclusive carotid stenosis >95% with distal lumen recovery (Group 2). CNO was defined by distal ICA caliber reduction and further classified by the presence of full distal collapse (≤2 mm). Preoperative characteristics, operative details, and 30-day outcomes were compared using χ² tests. Long-term survival, ipsilateral stroke, stroke-free survival, and freedom from restenosis were evaluated using Kaplan–Meier analysis and compared with the log-rank test.

Results: Patients in Group 2 were older than those in Group 1 (76 ± 8 vs 72 ± 8 years; p< 0.001), while cardiovascular risk factors were comparable. In Group 1, 33 patients (41%) presented full distal collapse. Symptomatic presentation was more frequent in Group 1 (35% vs 24%, p=0.07), and concordant ipsilateral ischemic brain lesions on preoperative imaging were significantly more common (25% vs 9%, p=0.001).
CEA was performed with similar anesthetic and surgical strategies in both groups, including selective shunt use and routine patch angioplasty (>90%). No 30-day deaths or major neurologic events occurred in Group 1. In Group 2, four perioperative strokes and one cardiac-related death were observed, resulting in a 30-day stroke/death rate of 3.4% (p=0.08 vs Group 1).
Median follow-up was 30 months (range 1–140). Estimated 6-year overall survival was 84% in Group 1 and 73% in Group 2 (p=0.1). Ipsilateral stroke at 6 years occurred in 0% of CNO patients compared with 8.5% in the preocclusive stenosis group (p=0.03). Stroke-free survival at 6 years was 84% in Group 1 and 71% in Group 2 (p=0.09). Freedom from restenosis at 6 years was 78.5% in Group 1 and 86.3% in Group 2 (p=0.2), with late carotid occlusion occurring more frequently in CNO patients (6% vs 0%, p=0.02).

Conclusions: CEA provides excellent perioperative safety and durable stroke prevention in patients with carotid near-occlusion, including those with distal collapse. Long-term neurologic outcomes are at least comparable, and in terms of ipsilateral stroke superior, to those observed in preocclusive stenosis. Higher rates of late restenosis and occlusion in CNO underline the need for structured and prolonged postoperative surveillance.