Evidence map›Paper›PMID 42888281›Full record

ArticleJournal of neurology2026

Risk of early stroke recurrence and procedural stroke or death in carotid near occlusion patients scheduled for carotid endarterectomy.

Henrietta Törmänen, Suvi Koskinen, Krista Nuotio, Riikka Tulamo, Pirkka Vikatmaa, Lauri Soinne, Perttu J Lindsberg, Petra Ijäs

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Article in Journal of neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

8 authors.

Henrietta TörmänenDepartment of Neurology, Helsinki University Hospital, Biomedicum 1, Haartmaninkatu 8, 00029, Helsinki, Finland. henrietta.tormanen@hus.fi.
Suvi KoskinenClinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland.
Krista NuotioDepartment of Neurology, Helsinki University Hospital, Biomedicum 1, Haartmaninkatu 8, 00029, Helsinki, Finland.
Riikka TulamoDepartment of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Pirkka VikatmaaDepartment of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Lauri SoinneClinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland.
Perttu J LindsbergDepartment of Neurology, Helsinki University Hospital, Biomedicum 1, Haartmaninkatu 8, 00029, Helsinki, Finland.
Petra IjäsDepartment of Neurology, Helsinki University Hospital, Biomedicum 1, Haartmaninkatu 8, 00029, Helsinki, Finland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCarotid near occlusion (NO) refers to distal internal carotid artery (ICA) narrowing caused by proximal carotid stenosis (CS). Stroke risk and optimal management of NO remain controversial. Our aim was to determine the prevalence of NO severities, rates of preoperative ischemic cerebrovascular events (iCVEs), 30-day procedural stroke and death, and hyperperfusion syndrome in patients with NO in a prospective CS cohort undergoing carotid endarterectomy (CEA).

methodsWe reanalyzed posthoc CTAs from 443 symptomatic and asymptomatic CS patients. Subtle NO (s-NO) was defined as a 1.0-mm difference in distal luminal diameter between ipsilateral and contralateral ICA. NO with full collapse (fc-NO) was defined as ≤2.0 mm and/or an ipsilateral-to-contralateral ICA diameter ratio ≤0.42. Conventional stenosis was defined as CS >50% using NASCET criteria. Rates of preoperative iCVEs and 30-day procedural stroke and death were compared between s-NO, fc-NO, and conventional stenosis.

resultsNO occurred in 143 (32%) patients: 124 (87%) s-NO and 19 (13%) fc-NO. NO was not significantly associated with increased preoperative iCVEs (7.6% vs 13%, OR 1.82, 95%Cl 0.96-3.47) or procedural stroke or death (5.6% vs 3.3%, OR 1.73, 95%Cl 0.67-4.50) compared with conventional stenosis. After CEA, hyperperfusion syndrome was frequent in NO patients (7.0% vs 2.7%, OR 2.8, 95% CI1.1-7.1). One patient developed fatal hyperperfusion-related intracranial hemorrhage.

conclusionCTA-detected NO is common, particularly in subtle forms, and important for stenosis assessment and management. Unlike earlier studies, NO was not associated with increased preoperative or procedural stroke or death, but hyperperfusion syndrome after CEA was more frequent.

Indexed as

Carotid StenosisEndarterectomy, CarotidPostoperative ComplicationsStrokeAgedAged, 80 and overCarotid Artery, InternalFemaleHumansMaleMiddle AgedProspective StudiesRecurrenceCarotid endarterectomyCarotid near occlusionHyperperfusion syndrome

Identifiers

PMID42888281

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.