ABSTRACT NUMBER: ESOC2026A58 STENTING VS ENDARTERECTOMY IN PATIENTS WITH HIGH-RISK ASYMPTOMATIC CAROTID STENOSIS

Abstract Background and aims The management of asymptomatic carotid stenosis (ACS) and the choice between carotid endarterectomy (CEA) and carotid artery stenting (CAS) remain controversial. Current guidelines recommend intervention for patients presenting with silent cerebral infarction, stenosis progression, unstable plaque morphology, microembolic signals, or impaired cerebrovascular reserve. The main objective was to compare complications and outcomes between CAS and CEA. Methods Observational, retrospective, single-center study. Adult patients with CAS >70% (NASCET) (January 2022-May 2024) treated with CEA/CAS were included. Demographic, clinical, and radiological variables were collected, and periprocedural complications and hospital mortality were evaluated. At one-month and one-year follow-up, clinical events and functional prognosis were determined using the modified Rankin scale (mRS). Results Fifty-nine patients with asymptomatic carotid stenosis (mean age 68 ± 7.1 years; 15% women) were included: 21 underwent carotid artery stenting (CAS) and 38 carotid endarterectomy (CEA). Periprocedural complications were similar (CAS 14.3%; CEA 13.2%). CAS complications included intrastent thrombosis, inguinal hematoma, and femoral pseudoaneurysm; CEA complications included recurrent laryngeal nerve injury (n=3) and cervical hematoma requiring reintervention (n=2). No in-hospital mortality occurred. At one month, one cardiovascular event and one cerebral hemorrhage were reported in the CEA group. No further events occurred at one year. At follow-up, all patients achieved a modified Rankin Scale (mRS) score ≤2. Conclusions: In our cohort, CAS and EAC showed similar rates of periprocedural complications, but EAC had more adverse events at one month. Both were safe, with no mortality and a good prognosis at one year. An individualized and multidisciplinary approach is crucial for decision-making. Conflict of interest Georgina Figueras-Aguirre: nothing to disclose