Carotid Endarterectomy (CEA) for Asymptomatic Carotid Artery Stenosis

Recently, many patients with asymptomatic carotid artery stenosis have been found with the increasing availability of MRA and 3D-CTA. There is a high risk of stroke in the future for such asymptomatic patients if they go without treatment.We had 50 CEAs of 49 patients with asymptomatic carotid artery stenosis and 122 CEAs of 122 patients with symptomatic stenosis. Surgical outcome and changes in intraoperative monitorings were compared between asymptomatic and symptomatic patients. There was no significant difference in the risk factors for CEA, such as ischemic heart disease, diabetic mellitus, and hypertension, between the two groups. The intraoperative monitoring such as measurements of blood flow of internal carotid artery, stump pressure, somatosensory evoked potential, and near infrared spectrophotometry were routinely applied to reduce surgical complications. There was also no difference in changes of parameters during CEA between the two groups. Overall mortality was 0, and morbidity was 4/172 (2.3%). Two of 50 CEAs with asymptomatic stenosis had permanent neurological deficits. In symptomatic patients, morbidity was 2/122. Statistically, there was no significant difference of morbidity rate between the two groups.We concluded that morphological evaluation of stenotic lesion, hemodynamic evaluation and intraoperative monitorings are important to reduce perioperative complications in both symptomatic and asymptomatic patients.