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Review
. 2020 Oct;8(19):1264.
doi: 10.21037/atm-20-1098.

Impact of cerebral ischemic lesions on the outcome of carotid endarterectomy

Rodolfo Pini  1 , Andrea Vacirca  1 , Sergio Palermo  1 , Enrico Gallitto  1 , Chiara Mascoli  1 , Mauro Gargiulo  1 , Gianluca Faggioli  1
Affiliations
Review

Impact of cerebral ischemic lesions on the outcome of carotid endarterectomy

Rodolfo Pini et al. Ann Transl Med. 2020 Oct.

Abstract

Patients with carotid artery stenosis (CAS) are commonly defined as asymptomatic or symptomatic according with their neurological conditions, however, emerging evidences suggest stratifying patients according also with the presence of cerebral ischemic lesions (CIL). In asymptomatic patients, the presence of CIL increases the risk of future neurologic event from 1% to 4% per year, leading to a stronger indication to carotid revascularization. In symptomatic patients, the presence of CIL does not seem to influence the outcome of the carotid revascularization if the volume of the lesion is small (<4,000 mm3); the benefit of the revascularization is also more significant if performed within 2 weeks from the index event. However, high volume (>4,000 mm3) CIL are associated in some experiences with a higher risk of carotid revascularization suggesting to delay the carotid revascularization for at least 4 weeks. As a matter of fact, the evaluation of CIL dimensions and characteristics in patients with CAS gives to the physician involved in the treatment a valuable adjunctive tool in the choice of the ideal treatment.

Keywords: Carotid artery stenosis (CAS); cerebral ischemic lesion (CIL); stroke.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-20-1098). The series “Carotid Artery Stenosis and Stroke: Prevention and Treatment Part I” was commissioned by the editorial office without any funding or sponsorship. The authors have no other conflicts of interest to declare.

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