Objective To systematically analyse prior reports of carotid endarterectomy (CEA) performed in cases of ≤50% carotid stenosis in order to understand patient tolerance and potential benefit. Methods A systematic review and descriptive analysis was performed in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An English-language search was performed of online databases using librarian-selected search terms. Abstracts were reviewed for relevance which included mention of carotid endarterectomy and stenosis. Prospective or retrospective observational cohort studies that reported series of patients who underwent endarterectomy for minimal (≤50%) luminal stenosis with reported outcomes were included. Results Six studies (which included our institutional series) with a total of 143 patients met the inclusion criteria. The weighted mean age at the time of CEA was 72.3 years; 113 (79.0%) were male. 55.8% of patients with available data had recurrent ipsilateral ischaemic events despite medical therapy. Two patients out of 129 with available perioperative data (1.6%) had perioperative MRI findings of acute ischaemic stroke, both within the hemisphere contralateral to the side of CEA. Of the 138 patients with available follow-up (mean, 36 months), none had recurrent ipsilateral ischaemic events. Conclusions Endarterectomy for symptomatic carotid disease causing ≤50% stenosis may be a potentially beneficial strategy to prevent stroke recurrence. Studies with robust methodology are needed to draw more definitive conclusions in terms of the safety and efficacy of endarterectomy for minimal stenosis with vulnerable features relative to intensive medical therapy. All data relevant to the study are included in the article or uploaded as supplemental information.

中文翻译：

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有症状的非狭窄颈动脉的动脉内膜切除术：系统评价和描述性分析

目的 系统分析颈动脉内膜切除术 (CEA) 的既往报告在 ≤ 50% 的颈动脉狭窄情况下进行，以了解患者的耐受性和潜在益处。方法 根据系统评价和元分析指南的首选报告项目进行系统评价和描述性分析。使用图书馆员选择的搜索词对在线数据库进行英语搜索。审查了摘要的相关性，其中包括提及颈动脉内膜切除术和狭窄。前瞻性或回顾性观察性队列研究报告了一系列因最小（≤50%）管腔狭窄而接受动脉内膜切除术并报告结局的患者。结果 共有 143 名患者的六项研究（包括我们的机构系列）符合纳入标准。CEA 时的加权平均年龄为 72.3 岁；113 (79.0%) 人为男性。尽管接受了药物治疗，但有可用数据的患者中，55.8% 的患者有复发性同侧缺血事件。129 名有可用围手术期数据的患者中有 2 名（1.6%）在围手术期 MRI 发现急性缺血性卒中，均在 CEA 对侧的半球内。在 138 名可进行随访（平均 36 个月）的患者中，均未出现复发性同侧缺血事件。结论 动脉内膜切除术治疗导致 ≤50% 狭窄的症状性颈动脉疾病可能是预防卒中复发的潜在有益策略。需要采用稳健的方法进行研究，以得出更明确的结论，即动脉内膜切除术相对于强化药物治疗对具有脆弱特征的最小狭窄的安全性和有效性。所有与研究相关的数据都包含在文章中或作为补充信息上传。