Predictive factors for postoperative cerebral infarction after carotid endarterectomy and stenting: A single-center experience from 199 consecutive cases.

BACKGROUND: Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are established treatments for carotid artery stenosis but may cause asymptomatic cerebral infarctions detectable by diffusion-weighted imaging (DWI). This study evaluated the incidence and risk factors for postoperative DWI-positive lesions following CEA and CAS at our institution.

METHODS: We retrospectively analyzed 199 patients who underwent CEA (n = 114) or CAS (n = 85) between January 2019 and December 2023. Preoperative black-blood magnetic resonance imaging (MRI) was performed to determine the plaque-to-muscle ratio (PMR). All participants underwent MRI on postoperative day 1.

RESULTS: DWI-positive lesions were significantly more common following CAS (27.1%) than after CEA (13.2%) (p = 0.0175). In the CAS group, age > 75 years was significantly associated with DWI-positive findings. PMR showed no significant association with DWI lesions in either group.

CONCLUSION: CAS was associated with a higher incidence of asymptomatic postoperative cerebral infarction in individuals > 75 years. Although PMR was not predictive of DWI lesions, advanced age emerged as a significant risk factor for embolic events after CAS. In older patients, the selection between CEA and CAS should be individualized, with procedural risks weighed against CAS's lower invasiveness, and reached through multidisciplinary discussion without undue preference.