Carotid endarterectomy benefits patients with CKD and symptomatic high-grade stenosis
Anna Mathew1, Michael Eliasziw, P J Devereaux
1University of Western Ontario, London, Ontario, Canada.
Insights
Patients with chronic kidney disease (CKD) and severe carotid artery stenosis benefit significantly from endarterectomy, experiencing a greater stroke risk reduction compared to those with healthy kidneys.
Area of Science:
- Neurology
- Nephrology
- Vascular Surgery
Background:
- Carotid endarterectomy is standard for symptomatic high-grade internal carotid artery stenosis.
- The benefit of this procedure in patients with chronic kidney disease (CKD) remains unclear.
Purpose of the Study:
- To evaluate the efficacy of carotid endarterectomy in reducing stroke risk for patients with symptomatic high-grade carotid stenosis and stage 3 CKD.
Main Methods:
- Re-analysis of data from the North American Symptomatic Carotid Endarterectomy Trial.
- Inclusion of patients with symptomatic stenosis and either stage 3 CKD (n=524) or preserved kidney function (n=966).
Main Results:
- Medically treated patients with CKD had a higher 2-year ipsilateral stroke risk (31.6% vs. 19.3%).
- Carotid endarterectomy reduced stroke risk by 82% in CKD patients and 51% in those with preserved renal function.
- Number needed to treat for stroke prevention was 4 for CKD patients versus 10 for others.
- CKD patients had similar perioperative stroke/death rates but higher cardiac event rates.
Conclusions:
- Patients with stage 3 CKD and symptomatic high-grade carotid stenosis experience substantial stroke risk reduction following endarterectomy.
- Endarterectomy is a highly beneficial intervention for this specific patient group.
Abstract:
Endarterectomy is generally recommended for symptomatic high-grade (70 to 99%) stenosis of the internal carotid artery, but whether this procedure is beneficial among patients with chronic kidney disease (CKD) is unknown. In this re-analysis of data from the North American Symptomatic Carotid Endarterectomy Trial, we included patients with symptomatic stenosis and either stage 3 CKD (n = 524) or preserved kidney function (n = 966; estimated GFR > or = 60). For medically treated patients with high-grade stenosis, risk for ipsilateral stroke at 2 yr was significantly higher in patients with CKD than in those with preserved renal function (31.6 versus 19.3%; P = 0.042); carotid endarterectomy significantly reduced this risk by 82 and 51%, respectively. To prevent one ipsilateral stroke, the number needed to treat by endarterectomy was four for patients with CKD and 10 for patients with preserved renal function. Compared with patients with preserved renal function, those with CKD had similar rates of perioperative stroke and death but higher rates of cardiac events. In conclusion, patients with stage 3 CKD and symptomatic high-grade carotid stenosis gain a large benefit in stroke risk reduction after endarterectomy.
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