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[Carotid endarterectomy: description, results and clinic evolution in 100 consecutive symptomatic patients]
Raúl Martínez Fernández1, Y Silva, E Gómez
1Servicio de Neurología, Institut d'investigació biomèdica de Girona, Hospital Doctor Josep Trueta, Girona. raulrail@hotmail.com
Insights
Carotid endarterectomy for symptomatic stenosis over 70% showed a 5% stroke-mortality rate, aligning with guidelines. Regular evaluation of surgical risks is crucial for maintaining acceptable standards in carotid endarterectomy procedures.
Area of Science:
- Vascular Surgery
- Neurology
- Public Health
Context:
- Carotid endarterectomy is a key procedure for secondary stroke prevention in patients with symptomatic stenosis >70%.
- Assessing perioperative risks is essential for the benefit of carotid endarterectomy.
- Limited published data exists on the outcomes of centers regularly performing this procedure.
Purpose:
- To analyze the incidence of surgical complications following carotid endarterectomy.
- To describe the stroke profile of patients undergoing the procedure.
- To compare institutional outcomes with established national and international series.
Summary:
- A consecutive series of 100 patients undergoing carotid endarterectomy for symptomatic stenosis >70% between 2002-2006 were analyzed.
- The study recorded stroke risk factors, clinical presentation, imaging findings, and perioperative complications.
- The overall stroke-mortality rate at three months was 5%, with subclinical hemodynamic changes being the most common complication.
Impact:
- The study demonstrates that carotid endarterectomy outcomes at this center are within acceptable guideline ranges.
- Periodic evaluation of surgical risks is recommended to ensure consistent quality of care.
- Findings contribute to the understanding of perioperative morbidity and mortality in carotid endarterectomy.
Introduction:
The efficacy of endarterectomy in symptomatic carotid stenosis greater than 70% in secondary stroke prevention has been demonstrated although the benefit is dependent upon the perioperative morbidity and mortality risk. Despite the recommendation that the results of centres regularly practicing endarterectomies be analysed and reported, few studies have in fact been published. The aim of our study was to analyze the incidence of surgical complications from carotid endarterectomy at our hospital and to describe the stroke profile of the operated patients.
Material And Methods:
100 consecutive patients submitted to carotid endarterectomy between 2002 and 2006 were included. We recorded stroke risk factors, clinical presentation, ultrasonography findings including transcranial and carotid eco-Doppler, neuroimaging, intra and perioperative complications including mortality- stroke rate, and clinical outcome at three months. We compare our results with the NASCET, ECST and Spanish published series.
Results:
Males predominated (74 % vs 26 %). The mean age was 70+/-8.5 years with 36 % of patients older than 75 years. Arterial hypertension was the most common vascular risk factor (74%), 14% had a critical contralateral carotid stenosis or occlusion. Stroke was the most frequent clinical presentation (67 %). The most commonly detected intraoperatory and postoperatory complication was subclinical haemodynamic changes (67% and 45% respectively). Cranial nerve lesions were the most usual local complication. Four patients suffered stroke recurrence, leading to death in one. A further patient died due to a reperfusion syndrome. The rate of stroke-mortality at three months was 5%.
Conclusions:
Morbidity and mortality related to carotid endarterectomy for symptomatic stenosis greater than 70 % was within guideline ranges. Surgical risk at every centre should be periodically evaluated in order to guarantee that acceptable standards are maintained.
