Is diabetes mellitus a risk factor for carotid endarterectomy? A prospective study

Although many randomized trials and other multicenter studies have demonstrated the benefits of carotid endarterectomy (CEA) in selected symptomatic and asymptomatic patients, several investigators have noted an increased rate of perioperative neurologic and cardiac morbidity in diabetic patients. To compare the perioperative outcome of CEA in diabetic patients (group I) versus nondiabetic patients (group II), we analyzed a consecutive series of CEAs performed by the same vascular surgeon at the same institution.

Data collection was prospective for all CEA procedures performed between August 1, 1992 and March 31, 1999. Group I and group II were matched for clinical presentation, percentage of internal carotid artery stenosis and indication for surgery.

of 547 CEAs performed in 474 patients, 199 (36.4%) were in group I. Group I was younger at presentation than group II (P <.005) and women were in a higher proportion in group I than in group II (43.7% vs 27.1%, P =.0001). Although the incidence of peripheral atherosclerotic disease was comparable in the 2 groups, there was a significantly higher incidence of previous vascular surgery in group I (P =.01). Perioperative neurologic and cardiac morbidity rates were comparable in the 2 groups. The overall perioperative mortality rate was 0.5%. Long-term information was obtained in all patients (mean, 44 months; range, 1 to 75 months). No differences were found in the recurrent stenosis and occlusion rates between the 2 groups. Although there was no difference in the late mortality between the 2 groups, diabetic patients had a significantly higher cardiac-related death incidence (P =.01) than nondiabetic patients.

The findings of this analysis indicate that CEA can be performed in diabetic patients with excellent perioperative morbidity and mortality rates and late stroke-free and survival rates that are comparable with those recorded in nondiabetic patients.