Influence of Collateral Circulation and Clamping Duration on Neurological Outcomes in Asymptomatic Patients after Carotid Endarterectomy

Abstract Asymptomatic carotid artery stenosis (ACS) is prevalent in approximately 2% of the general population and increases with age. Identifying high-risk patients for neurological complications during elective carotid endarterectomy (eCEA) is critical for improving surgical outcomes. This retrospective cohort study included 70 asymptomatic patients with carotid artery stenosis >70%, treated with eCEA between January and July 2023. Patients were classified based on the morphology of the Circle of Willis (CoW) into complete and incomplete groups. Primary outcomes were postoperative stroke, transient ischemic attack (TIA), and neurological mortality. Additional variables included risk factors and clamping duration. The frequency of incomplete CoW was significantly higher in men (p=0.004). Neurological complications were observed in 2 patients (2.9%). There was no significant association between risk factors and postoperative complications. However, longer clamping duration was significantly associated with neurological complications (p=0.034). Interestingly, the absence of anatomical CoW variations did not correlate with post-operative complications, suggesting effective compensatory collateral flow. Neurological complications in eCEA are low and more closely related to clamping duration than CoW morphology. Effective preoperative assessment and surgical technique are essential for minimising risks.