• Koji Shimonaga, Taichi Ikedo, Naoto Yamada, Akihiro Niwa, Yuji Kushi, Eika Hamano, Kiyofumi Yamada, Hirotoshi Imamura, Hisae Mori, Kinta Hatakeyama, Koji Iihara, and Hiroharu Kataoka.
• Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan. Electronic address: koji.shimoshimo@gmail.com.
• World Neurosurg. 2024 Mar 1; 183: e886e891e886-e891.

ObjectiveSurgical indications for low-grade carotid stenosis have not yet been established. This study aimed to clarify the characteristics of low-grade carotid stenosis refractory to medical treatment.MethodsWe retrospectively analyzed 48 patients with symptomatic low-grade carotid stenosis (<50%). Recurrence was defined as an ipsilateral ischemic event in the symptomatic lesions during the follow-up period. Patient demographics and imaging findings were compared between the recurrence and nonrecurrence groups to investigate risk factors associated with medical treatment.ResultsThe mean age was 74.1 (58-90 years), and the mean follow-up period was 35.4 months (2.0-97 months). Recurrence occurred in 15 of the symptomatic patients. Ulceration was significantly associated with recurrence under medical treatment (P = 0.001). The median time to recurrence was 26.1 months in patients with ulcers and 54.3 months in those without ulcers (P = 0.04). Pathological study with recurrence showed plaque rupture with multilayered lesions, indicating lesions refractory to medical treatment.ConclusionsIn cases of low-grade carotid stenosis, lesions with ulcerations are likely refractory to medical therapy. Consideration of the indications for surgical treatment may be warranted for lesions with ulceration, even if the degree of stenosis is low.Copyright © 2024 Elsevier Inc. All rights reserved.

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