Aortic Dissection

Objectives: This study aimed to investigate the natural course of the contralateral carotid artery atherosclerotic disease after patients were treated with CEA. Identifying the incidence of the development of new contralateral carotid artery lesion and its association with potencial clinical risk factors constitute our endpoints.

Methods: A total of 501 consecutive CEA for symptomatic and asymptomatic internal carotid artery (ICA) disease were performed from January 2000 to October 2023 at the hospitals ( Ana Nery and Santa Cruz) of Santa Cruz do Sul by the first author. From this group, we identified 407 patients who had undergone first-time CEA, as well as preoperative images exam of the carotid arteries and at least one postoperative. The stenosis of the internal carotid artery (ICA) was classified as none (0-29%), mild (30-49%), moderate (50-69%), severe (70-99%) or occluded. Progression was defined as any progress to a higher category of stenosis. The association of carotid stenosis progression and clinical risk factors was also analyzed.

Results: Mean patient age was 69,4 years (40-88 years). Forty-two patientes were found to have contralateral carotid occlusion at the time of the CEA, and were therefore excluded from the contralateral progression analyses. The median (25-75%) follow up for images exams of the carotid arteries after CEA was 47 months (14-82 months) . For the reaminding 365 patients carotid artery stenosis progressed in 92 patients ( 25,2%) . The median (25-75%) time to progression of contralateral carotid for moderate stenosis was 65,5 months (26-104 months) and 35 months ( 23,5-66 months) . Late contralateral carotid intervention was performed in the entire serie of 407 pacients , in 43 patients ( 10,5%). In the univariate Cox regression, there was no significant association between clinical parameters and the progression of contralateral stenosis. However, in the multivariate Cox regression, there was a significant association for female gender 1.61 (1.06-2.44, p = 0.025) and PAD 1.55 (1.01-2.40, p = 0.046) with the progression of contralateral stenosis

Conclusions: A significant number of pacientes after CEA experience progression of contralateral carotid disease. The serveillance of pacients with carotid artery stenosis should consider in long term, with incrase atention to those with risk factors like peripheral arterial disease and female sex.