Carotid near occlusion was not significantly associated with increased preoperative ischemic cerebrovascular events or procedural stroke or death compared with conventional stenosis, but hyperperfusion syndrome after carotid endarterectomy was more frequent in near occlusion patients.
Near occlusion occurred in 32% of carotid stenosis patients undergoing CEA, with the majority being subtle near occlusion.
Near occlusion was not significantly associated with increased preoperative ischemic cerebrovascular events compared with conventional stenosis.
Near occlusion was not significantly associated with increased 30-day procedural stroke or death compared with conventional stenosis.
Hyperperfusion syndrome after CEA was significantly more frequent in near occlusion patients compared with conventional stenosis patients.
Subtle near occlusion was defined by a 1.0-mm difference in distal luminal diameter between ipsilateral and contralateral ICA, while full collapse near occlusion required a distal ICA diameter ≤2.0 mm and/or an ipsilateral-to-contralateral ICA diameter ratio ≤0.42.
CTA-detected near occlusion is considered important for stenosis assessment and management, particularly because of its association with post-CEA hyperperfusion syndrome.
This research looked at a condition called carotid near occlusion, where the internal carotid artery (which supplies blood to the brain) becomes narrowed downstream due to a blockage upstream. The researchers reanalyzed CT angiography scans from 443 patients who were scheduled for carotid endarterectomy — a surgical procedure to remove arterial plaque — to understand how common near occlusion is and what risks it carries. They found that nearly one in three patients had near occlusion, and the vast majority of these cases were a milder 'subtle' form rather than the more severe 'full collapse' form. Contrary to previous studies, this research suggests that having near occlusion did not significantly increase the chances of a stroke before surgery or within 30 days after surgery compared to patients with conventional carotid artery narrowing. However, near occlusion patients were about three times more likely to develop a condition called hyperperfusion syndrome after surgery — where blood flow to the brain suddenly increases after a long period of reduced flow, potentially causing dangerous complications. One patient in this group died from a brain bleed caused by this syndrome. This research suggests that identifying near occlusion before carotid endarterectomy is clinically important, not because it dramatically raises stroke risk in the lead-up to or during surgery, but because it flags patients who may need closer monitoring after surgery for hyperperfusion syndrome. The findings may help surgeons and neurologists better prepare for and manage potential complications in this patient group.
Törmänen H, Koskinen S, Nuotio K, Tulamo R, Vikatmaa P, Soinne L, et al.. (2026). Risk of early stroke recurrence and procedural stroke or death in carotid near occlusion patients scheduled for carotid endarterectomy.. Journal of neurology. https://doi.org/10.1007/s00415-026-14198-x