Abstract

Backgroundː Residual carotid artery lesions following eversion endarterectomy may predispose patients to restenosis and adverse clinical outcomes. This study investigated the influence of preoperative atherosclerotic plaque length and composition on the development of residual lesions after eversion endarterectomy.
Methodsː A retrospective analysis was conducted on patients who underwent eversion endarterectomy between January 2021 and October 2022 and had available carotid computed tomography angiography (CTA) scans both preoperatively and within 3 months postoperatively. Preoperative CTA was assessed for stenosis severity and plaque length, while postoperative CTA was reviewed for residual lesions. Resected plaque specimens were subjected to routine histopathological evaluation to determine plaque composition.
Resultsː A total of 42 patients (mean age, 71.3 ± 8.4 yr) were included in the study. Postoperative residual lesions were identified in six patients (14.3%). Histological analysis showed no statistically significant association between plaque composition and the presence of residual lesions. However, increased preoperative plaque length was significantly associated with residual lesions (odds ratio [OR], 1.171; 95% confidence interval [95% CI], 1.028–1.333; p = 0.0017). Receiver operating characteristic curve analysis identified a cutoff plaque length of 22.5 mm (area under the curve, 0.769; 95% CI, 0.541–0.996; p = 0.037) for predicting residual lesions.
Conclusionː Longer preoperative plaque length on carotid CTA was significantly associated with the presence of residual lesions following eversion endarterectomy. This finding suggests that increased plaque length may reflect more extensive atherosclerotic involvement of the carotid artery, potentially contributing to suboptimal surgical outcomes.

Key words: Atherosclerotic plaque, Carotid artery disease, Eversion carotid endarterectomy, Plaque length, Residual lesion