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Preoperative risks predict neurological outcome of carotid endarterectomy related stroke
F E Sieber1, T J Toung, M N Diringer
1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland.
Insights
Neurological risks and angiographic risks predict poor stroke outcomes after carotid endarterectomy. Surgical complications, particularly carotid thrombosis, were more strongly linked to stroke than medical issues.
Area of Science:
- Vascular Surgery
- Neurology
- Clinical Risk Assessment
Background:
- Carotid endarterectomy is a common procedure to prevent stroke.
- Identifying preoperative risk factors for poor stroke outcomes is crucial for patient management.
Purpose of the Study:
- To determine if preoperative risk factors predict poor stroke outcomes after carotid endarterectomy.
- To assess the impact of other stroke risk factors on stroke severity.
Main Methods:
- Retrospective review of 561 carotid endarterectomy cases over 10 years.
- Patients categorized into four groups based on preoperative risks: none, angiographic, medical, and neurological.
- Analysis of intraoperative, surgical, and medical complications associated with stroke occurrence.
Main Results:
- Overall stroke incidence was 5%, with 3.4% resulting in poor outcomes.
- Groups with angiographic risks (Group 2) and neurological risks (Group 4) had the highest stroke incidence (10% and 14%).
- Group 4 showed the highest incidence of poor-outcome stroke (12%). Surgical complications, especially carotid thrombosis, were more frequently associated with stroke than medical complications.
Conclusions:
- Neurological and angiographic risk factors are significant predictors of poor stroke outcomes post-carotid endarterectomy.
- Surgical complications, particularly carotid thrombosis, are more strongly associated with stroke than medical complications.
Abstract:
The aim of this study was to determine if preoperative risk factors are predictors of poor stroke outcome after carotid endarterectomy. In addition, the effect of other stroke risk factors on stroke severity was determined. A retrospective review of carotid endarterectomy results spanning 10 years, encompassing 561 patients, and reporting the combined results of all surgeons at our institution was performed. Patients were assigned to one of four groups. There were 227 patients with no preoperative risks (Group 1), 61 with angiographic risks (Group 2), 196 with medical risks with or without angiographic risks (Group 3), and 77 with neurological risks with or without medical/angiographic risks (Group 4). Other risks associated with stroke occurrence were recorded including: intraoperative risks (cross-clamp time, use of shunt, use of glucose solutions), surgical complications (carotid occlusion/thrombus or ligation), and medical complications (hypoxia, myocardial infarct). Stroke incidence was 5% with 2% (11 patients) and 3.4% (19 patients) having good and poor outcomes, respectively. Stroke incidence was highest in Groups 2 and 4 (10 and 14%, respectively), and Group 4 had the highest incidence of poor-outcome stroke (12%). Cross-clamp time, intraoperative shunt placement, and intraoperative glucose administration were similar among preoperative risk groups and were not primary determinants of stroke severity. The most common medical complication was myocardial infarction, which had the highest incidence in Groups 3 and 4 (6.1 and 5%, respectively). The highest incidence of surgical complications occurred in Groups 2 and 4, carotid thrombosis being the most common event (16 patients). Surgical complications were more commonly associated with stroke than were medical complications.(ABSTRACT TRUNCATED AT 250 WORDS)