Comparative effects of endarterectomy and balloon angioplasty with stent implantation on carotid artery flow velocity in carotid artery stenosis

Hemodynamically significant carotid artery stenosis is a major, modifiable contributor to ischemic stroke/transient ischemic attack (TIA), and both carotid endarterectomy (CEA) and carotid artery stenting (CAS) are established revascularization strategies aimed at restoring cerebral perfusion and normalizing carotid flow hemodynamics. This prospective study compared the outcomes of CEA and CAS with balloon angioplasty and stent implantation in patients with hemodynamically significant internal carotid artery stenosis. The goal was to assess the effectiveness of the techniques in reducing peak systolic velocity and improving quality of life. Between March 2019 and December 2020, 106 patients (47% male, 53% female; aged 40–75 years) were enrolled at the Rzeszów Center for Vascular and Endovascular Surgery, Poland. Inclusion criteria encompassed symptomatic stenosis ≥70% or selected 50–69%, as well as asymptomatic cases meeting clinical indications (e.g., prior stroke/TIA, plaque morphology, anatomy, comorbidities). Patients were assigned to the CEA or CAS group based on multidisciplinary evaluation; exclusions included lack of consent or surgical contraindications. All patients received perioperative antiplatelet therapy and statins. Evaluations included duplex ultrasound to measure peak systolic velocity and stenosis degree before the procedure and at 1 month post-intervention, along with quality-of-life questionnaires. Data were analyzed using Student’s t-tests. Preoperative peak systolic velocities differed between groups, with overall higher values in CAS and gender-specific variations (men: 363.21 cm/s in CEA vs. 345 cm/s in CAS; women: 338.97 cm/s in CEA vs. 354.96 cm/s in CAS). Both interventions led to statistically significant postoperative reductions in blood flow velocity. Postoperative hemodynamic improvements and quality-of-life outcomes were comparable between groups, with similar comorbidity impacts observed. These results indicate that CEA and CAS offer equivalent short-term effectiveness in managing carotid artery disease and reducing stroke/TIA risk.