Age‐Related Anatomical Changes in Carotid Artery Stenosis and Its Impact on Postoperative Complications in Stenting and Endarterectomy

TL;DR

This study shows that age-related changes in carotid artery anatomy increase complications after stenting or surgery, and a model can predict these risks.

Contribution

The study identifies age-related anatomical predictors of complications in carotid procedures and introduces an effective logistic regression model for prediction.

Findings

Older age correlates with larger CCA diameter, shorter clavicle-to-bifurcation distance, and increased tortuosity.

Age-related anatomical changes significantly increase complication rates in both CAS and CEA.

A logistic regression model predicted CAS complications with high accuracy (AUC = 0.82).

Abstract

Carotid artery stenosis increases the risk of ischemic stroke, with carotid endarterectomy (CEA) and carotid artery stenting (CAS) as primary interventions. Age‐related vascular changes may contribute to complications. This study aimed to evaluate the impact of age‐related vascular changes on postoperative complications and procedural outcomes.

A retrospective cohort of 470 patients who underwent CAS or CEA from January 2020 to November 2021 was analyzed. Demographics, anatomical characteristics, and postoperative complications were assessed. Correlation, regression analyses, and machine learning models were applied to identify predictors of adverse outcomes.

Postoperative complications occurred in 64.9% of CAS and 75.2% of CEA patients. Older age correlated with larger CCA diameter, shorter clavicle‐to‐bifurcation distance, and increased tortuosity of both CCA and ICA. Several age‐related anatomical changes were significantly linked to higher complication rates in both procedures. In CAS, key predictors included symptomatic stenosis, aortic arch variation, CCA ostial lesions, and CCA diameter (p < 0.05). A logistic regression model predicted CAS complications effectively (AUC = 0.82).

This study highlights significant age‐related changes in carotid artery anatomy and their impact on postoperative complications. These findings underscore the importance of considering age‐related vascular remodeling to enhance patient selection and optimize surgical outcomes.

Using a clinical cohort of 429 patients, this study identified age‐related carotid anatomical changes—such as increased tortuosity, arterial stiffness, and CCA diameter variation—that were significantly associated with CAS/CEA complications. A logistic regression model accurately predicted CAS complications (AUC = 0.82), outperforming multiple machine learning methods. Findings may aid in optimizing patient selection and surgical planning in the elderly.

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