{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:45:08Z","timestamp":1760060708822,"version":"build-2065373602"},"reference-count":20,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T00:00:00Z","timestamp":1758499200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Harvard Medical School\u2019s Polish Clinical Scholars Research Training Program"},{"name":"Agencja Badan Medycznych (ABM, English: Medical Research Agency, Warsaw, Poland)"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Carotid artery stenting (CAS) is a common revascularization approach for carotid artery stenosis. While its impact on the internal carotid artery (ICA) has been extensively studied, the effects on the external carotid artery (ECA)\u2014a key collateral pathway for cerebral perfusion\u2014remain insufficiently explored. This study aimed to assess structural changes in the ECA following CAS and their clinical significance. Methods: A retrospective observational cohort study of 963 patients treated with CAS between 2018 and 2024 was conducted. Demographic data, comorbidities, and procedural characteristics were collected. Pre- and postprocedural ICA and ECA diameters were measured via angiography. Spearman\u2019s correlation, regression modeling, and receiver operating curver (ROC) analysis were used to identify predictors of ECA narrowing and occlusion and their relationship with neurological outcomes. Results: The median ECA diameter decreased post-CAS (from 4.7 mm to 3.8 mm, p &lt; 0.001). ECA overstenting occurred in 96.4% of cases, with 71.7% exhibiting diameter reduction. De novo ECA occlusion occurred in 2.5% of patients and was associated with a higher incidence of stroke, transient ischemic attack, and in-stent restenosis (ISR). Multivariate analysis identified preoperative ECA diameter (p &lt; 0.001), ICA diameter (p = 0.001), and second-generation stents (p = 0.02) as independent predictors of ECA narrowing. ROC analysis confirmed that a preoperative ECA diameter \u2264 3.05 mm strongly predicted occlusion (Area under the curve (AUC) = 0.93, p &lt; 0.001). Conclusions: CAS frequently leads to ECA remodeling, including occlusion, compromising collateral perfusion and contributing to adverse ischemic incidences and ISR. Preprocedural ECA assessment may aid in optimizing patient selection and procedural planning.<\/jats:p>","DOI":"10.3390\/jcm14186682","type":"journal-article","created":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T17:08:17Z","timestamp":1758560897000},"page":"6682","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Impact of External Carotid Artery Remodeling Following Carotid Artery Stenting"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5812-5090","authenticated-orcid":false,"given":"Dorota","family":"\u0141yko-Morawska","sequence":"first","affiliation":[{"name":"Department of General Surgery, Vascular Surgery, Angiology and Phlebology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 45-47 Zio\u0142owa Street, 40-635 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5154-2901","authenticated-orcid":false,"given":"Micha\u0142","family":"Serafin","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Vascular Surgery, Angiology and Phlebology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 45-47 Zio\u0142owa Street, 40-635 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3053-8817","authenticated-orcid":false,"given":"Julia","family":"Szostek","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Vascular Surgery, Angiology and Phlebology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 45-47 Zio\u0142owa Street, 40-635 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8702-9406","authenticated-orcid":false,"given":"Magdalena","family":"M\u0105ka","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Vascular Surgery, Angiology and Phlebology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 45-47 Zio\u0142owa Street, 40-635 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8636-5441","authenticated-orcid":false,"given":"Iga","family":"Kania","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Vascular Surgery, Angiology and Phlebology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 45-47 Zio\u0142owa Street, 40-635 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0927-0977","authenticated-orcid":false,"given":"Wac\u0142aw","family":"Kuczmik","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Vascular Surgery, Angiology and Phlebology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 45-47 Zio\u0142owa Street, 40-635 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"North American Symptomatic Carotid Endarterectomy Trial Collaborators (1991). 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Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/18\/6682\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:47:19Z","timestamp":1760035639000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/18\/6682"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,22]]},"references-count":20,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["jcm14186682"],"URL":"https:\/\/doi.org\/10.3390\/jcm14186682","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,9,22]]}}}