Background and Aims

Carotid Endarterectomy (CEA) is the standard treatment for patients with symptomatic carotid stenosis. Data from Low- and Middle-Income Countries (LMIC) is sparse on CEA and its outcome. We aimed to describe the clinical profile and predictors of periprocedural events in patients with symptomatic carotid stenosis who underwent CEA at our institute.

Methods

A retrospective review of patients with symptomatic carotid stenosis(50-99%) who underwent CEA between January 2011 and December 2021 was done. The clinical and imaging parameters and their influence on periprocedural events were analyzed.

Results

Of the 319 patients (77% males) with a mean age of 64 years (SD ±8.6), 207 patients(65%) presented with stroke. The majority (85%) had high-grade stenosis of the symptomatic carotid. The mean time to CEA was 50 days (SD ±36), however, only 26 patients (8.2%) underwent surgery within 2 weeks. Minor strokes and TIA occurred in 2.2%, while major strokes and death occurred in 4.1% of patients. None of the clinical or imaging parameters predicted the periprocedural adverse events except the presence of hemodynamic infarcts(12.8% vs 4.8%; P=0.019). The presence of co-existing significant(>50%) tandem intracranial atherosclerosis(24%) and the presence of contralateral carotid occlusion(7.5%) were not predictors of the periprocedural stroke risk(P=0.12 and 0.09 respectively).

Conclusions

There is a delay in patients undergoing CEA for symptomatic carotid stenosis. The majority have high-grade stenosis and present only after a stroke. CEA can be performed safely in patients with significant intracranial tandem stenosis and contralateral carotid occlusion.

Background and Aims

Identification of computed tomography (CT) thrombus imaging characteristics can predict the degree of recanalization and outcome after endovascular thrombectomy (EVT) in patients with acute ischaemic stroke and large vessel occlusion.

Aim: We analyzed the thrombus imaging characteristics and procedural factors and correlated with the degree of recanalization and functional outcome after EVT.

Methods

We evaluated the thrombus imaging characteristics (hyperdense MCA sign, thrombus location, length and permeability) from thin slice CT and CT angiogram. In addition, groin to recanalization time, number of passes, and EVT technique were documented. The primary outcome was degree of recanalization (mTICI score) and secondary outcome was modified Rankin scale (mRS) at 3 months.

Results

The mean age of 102 patients was 60.5±11.8 years. Patients with hyperdense MCA sign (90 % vs 75%, p=0.07) and permeable thrombus (86 % vs 70 %, p=0.09) had good recanalization (mTICI grade 2b,2c or 3). The requirement of <3 passes (90 % vs 62 %, p= 0.001) was associated with good recanalization. Multiple logistic regression analysis showed thrombus permeability (OR 5.9; 95% CI 1.3-26.6, p=0.02), use of stent retreiver alone (without aspiration) (OR 5.4; 95% CI 1.3-22.5, p=0.02) and a puncture to recanalization ≤60 minutes (OR 7.9; 95% CI 1.7-36.8; p=0.008) were associated with good recanalization. The requirement of ≥3 passes was associated with poor functional outcome (OR 3.4 ;95% CI 1.2-9.8; p=0.02).

Conclusions

Thrombus permeability was a predictor of successful recanalization after EVT. The requirement of three or more passes during EVT was associated with poor recanalization and poor functional outcome.