{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,3,29]],"date-time":"2025-03-29T04:10:34Z","timestamp":1743221434229,"version":"3.40.3"},"reference-count":49,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\nBackground<\/jats:title>\nThis study aimed to explore how clinical and radiological profiles of patients undergoing carotid endarterectomy (CEA) have changed over the past 40 years.<\/jats:p>\n<\/jats:sec>\n\nMethods<\/jats:title>\nWe included our three Japanese case series of CEA in the late 1980s (n<\/jats:italic> = 73), the 2000s (n<\/jats:italic> = 142), and the 2010s (n<\/jats:italic> = 108). We precisely compared the patients\u2019 demographics, clinical features, radiological findings, and short- and long-term outcomes among the three cohorts. CEA was performed with general anesthesia, routine use of an internal shunt tube, intraoperative monitoring using somatosensory evoked potential or near-infrared spectroscopy, precise and bloodless manipulation using an operating microscope, and primary closure.<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\nThe mean age of patients significantly increased from 55 years to 73.6 years during these 40 years (P<\/jats:italic> < 0.01). The incidence of patients with more than 90% stenosis significantly decreased from 54.9% to 24.5% (P<\/jats:italic> < 0.01), while the incidence of patients with mild stenosis significantly increased from 4.2% to 29.4% between the 2000s and 2010s (P<\/jats:italic> < 0.01). The incidence of patients with impaired cerebral hemodynamics significantly decreased from 41% to 21% (P<\/jats:italic> < 0.01). The frequency of transient ischemic attack markedly decreased from 33% to 10%, while the frequency of ischemic stroke significantly increased from 48% to 80% (P<\/jats:italic> < 0.01). Annual risk of ipsilateral stroke during follow-up periods decreased from 2.1% to 0.2% over the time.<\/jats:p>\n<\/jats:sec>\n\nConclusion<\/jats:title>\nThis study demonstrates significant differences in the demographics, radiological findings, and clinical results among patients undergoing CEA over 40 years, probably because of the patient\u2019s lifestyle, advances in imaging techniques, understanding of the pathophysiology, advances in medical therapy, selection criteria of candidates for CEA, and treatment guidelines.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_152_2025","type":"journal-article","created":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T10:21:07Z","timestamp":1743157267000},"page":"113","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical and radiological profie changes of patients undergoing carotid endarterectomy over 40 years"],"prefix":"10.25259","volume":"16","author":[{"given":"Satoshi","family":"Kuroda","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Toyama, Toyama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daina","family":"Kashiawzaki","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Toyama, Toyama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shusuke","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Toyama, Toyama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kunitaka","family":"Maruyama","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Toyama, Toyama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naoki","family":"Akioka","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Toyama, Toyama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emiko","family":"Hori","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Toyama, Toyama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyo","family":"Noguchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2025,3,28]]},"reference":[{"key":"10.25259\/SNI_152_2025\/ref-1","first-page":"31","article-title":"Comprehensive hybrid strategy for carotid artery stenosis with 8 rules \u201ctoyama carotid 8\u201d","volume":"44","author":"Akioka","year":"2016","journal-title":"No Shinkei Geka"},{"key":"10.25259\/SNI_152_2025\/ref-2","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1161\/01.STR.19.1.108","article-title":"Prognosis of high-risk patients with nonoperated symptomatic extracranial carotid tight stenosis","volume":"19","author":"Bogousslavsky","year":"1988","journal-title":"Stroke"},{"key":"10.25259\/SNI_152_2025\/ref-3","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/S0140-6736(14)61184-3","article-title":"Long-term outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: The international carotid stenting study (ICSS) randomised trial","volume":"385","author":"Bonati","year":"2015","journal-title":"Lancet"},{"key":"10.25259\/SNI_152_2025\/ref-4","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/j.ejvs.2022.07.048","article-title":"A systematic review and meta-analysis of carotid artery stenting for the treatment of cervical carotid artery dissection","volume":"64","author":"Bontinis","year":"2022","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"10.25259\/SNI_152_2025\/ref-5","doi-asserted-by":"crossref","first-page":"27","DOI":"10.3171\/2015.1.JNS142452","article-title":"Contemporary carotid imaging: From degree of stenosis to plaque vulnerability","volume":"124","author":"Brinjikji","year":"2016","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_152_2025\/ref-6","doi-asserted-by":"crossref","first-page":"e100084","DOI":"10.1371\/journal.pone.0100084","article-title":"The effects of the mediterranean diet on biomarkers of vascular wall inflammation and plaque vulnerability in subjects with high risk for cardiovascular disease. 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