Late outcome of patients with premature carotid atherosclerosis after carotid endarterectomy

Background and Purpose: The durability of carotid endarterectomy (CEA) in young adults with premature carotid atherosclerosis has not been adequately assessed. This study examined the late recurrence and mortality rates in young adults undergoing CEA. Methods: We studied 42 young patients (mean age. 45.5±0.5 years) who underwent CEA and compared them with 110 older control subjects (mean age, 65.8±0.4 years) undergoing CEA during the same period. Data were collected regarding demographics, operative indications, follow-up carotid duplex studies, recurrent symptoms, and deaths. Results: Demographics and atherosclerotic risk factors were similar between the two groups. During a mean follow-up of 57.9±6.0 months, 10 (24%) young patients and 3 (3%) control subjects developed significant, recurrent ipsilateral stenoses (≤50% diameter loss) (P<.001). Six (14%) young patients and 1 control subject had recurrent ipsilateral symptoms (P=.002). Nine (21%) young patients and 26 (24%) older control subjects required contralateral CEA; 8 (18%) young patients and 18 (16%) older control subjects underwent lower extremity revascularization procedures. Cumulative 5-year survival by life-table analysis was 0.83 (95% confidence interval [CI], 0.71 to 0.95) for study patients and was 0.67 (95% CI, 0.58 to 0.77) for control subjects (P=.06). Conclusions: These data demonstrate a trend toward more favorable survival in young versus older patients after CEA; however, survival differences did not achieve statistical significance. Young patients are far more likely to develop recurrent symptoms and recurrent carotid stenoses than older counterparts. Close follow-up with serial duplex ultrasound may be important in young patients after CEA.