Carotid endarterectomy for symptomic and asymptomic stenosis: Report of 65388 cases (Russian register).

Aim: Analysis of in-hospital and long-term results of carotid endarterectomy in patients with asymptomatic and symptomatic stenoses.

Materials And Methods: The sample was formed by completely including all cases of carotid endarterectomy ( = 65,388) performed during the period from May 1, 2015 to November 1, 2023. Depending on the symptomatic/asymptomatic nature of the stenosis, all patients were divided into two groups: group 1 - = 39,172 (75.2%) - patients with asymptomatic stenosis; Group 2 - = 26216 (24.8%) - patients with symptomatic stenosis. The postoperative follow-up period was 53.5 ± 31.4 months.

Results: In the hospital postoperative period, the groups were comparable in the incidence of death (group 1: = 164 (0.41%); group 2: = 124 (0.47%); = .3), transient ischemic attack (group 1: = 116 (0.29%); group 2: = 88 (0.33%); = .37), myocardial infarction (group 1: = 32 (0.08%); group 2: = 19 (0.07%); = .68), thrombosis of the internal carotid artery (group 1: = 8 (0.02%); group 2: = 2 (0.007%); = 0, 19), bleeding (group 1: = 58 (0.14%); group 2: = 33 (0.12%); = .45). In group 2, ischemic stroke developed statistically more often (group 1: = 328 (0.83%); group 2: = 286 (1.09%); = .001), which led to a higher value of the combined endpoint (group 1: = 640 (1.63%); group 2: = 517 (1.97%); = .001). In the long-term postoperative period, the groups were comparable in cases of death (group 1: = 65 (0.16%); group 2: = 41 (0.15%); = .76) and death from cardiovascular causes (group 1: = 59 (0.15%); group 2: = 33 (0.12%); = .4). A greater number of ischemic strokes were detected in patients of group 2 (group 1: = 213 (0.54%); group 2: = 187 (0.71%); = .006). In group 1, hemodynamically significant restenosis (≥70%) of the internal carotid artery was more often diagnosed (group 1: = 974 (2.49%); group 2: = 351 (1.34%); < .0001) and myocardial infarction (group 1: = 66 (0.16%); group 2: = 34 (0.13%); < .0001). When analyzing stroke-free survival, analysis of Kaplan-Meier curves showed that a statistically larger number of strokes were diagnosed in group 2 ( < .0001).

Conclusion: Due to the fact that the patients were initially not comparable for a number of indicators, to achieve balance, we applied propensity score matching analysis. Thus, group 1 consisted of 24,381 patients, and group 2 consisted of 17,219 patients. In the hospital postoperative period, statistically significant differences were obtained only in the combined end point, which was greater in group 2 (group 1: = 465 (1.9%); group 2: = 382 (2.2%); = .02). In the long-term follow-up period, after applying propensity score matching, no statistically significant differences were obtained between groups.