Abstract

Aim: Stroke ranks as the third leading cause of death worldwide after myocardial infarction and cancer. Carotid artery stenosis, primarily due to atherosclerotic plaque buildup, can result in transient ischemic attacks (TIAs) and stroke. Carotid endarterectomy (CEA) is a key treatment for symptomatic and asymptomatic patients with severe stenosis, with plaque characteristics—whether stable or unstable—affecting symptom risk and outcomes. Examining the link between plaque morphology and symptoms is essential for surgical decision-making. This study assesses the relationship between plaque characteristics and symptoms in CEA patients at Mersin University, focusing on stability differences between symptomatic and asymptomatic cases.
Material and Methods: In this retrospective cohort study, 152 symptomatic and asymptomatic CEA patients were analyzed. Plaques were classified as stable or unstable based on surface smoothness, ulceration, thrombus presence, and intraplaque hemorrhage. Key demographics, comorbidities, and imaging data from ultrasonography, computed tomography (CT), angiography, and magnetic resonance (MR) Angiography were reviewed.
Results: Stable plaques were more common in asymptomatic patients, while unstable plaques with features such as ulceration and thrombus were predominantly observed in symptomatic cases. A significant correlation was found between unstable plaques and neurological symptoms, suggesting that preoperative plaque assessment could be vital for surgical planning.
Conclusion: This study suggests that integrating plaque morphology with stenosis severity in CEA planning may enhance treatment success and reduce neurological risks. Assessing unstable plaque characteristics offers improved risk prediction, potentially supporting better long-term outcomes.

Key words: Carotid artery, endarterectomy, atherosclerosis, plaque characterization