Complication rates after left- versus right-sided carotid endarterectomy

Area of Science:

• Vascular Surgery
• Neurosurgery
• Clinical Outcomes Research

Background:

• The side of carotid endarterectomy (CE) may impact postoperative complication rates.
• Existing studies suggest a potential difference in outcomes based on the surgical side.

Purpose of the Study:

• To analyze individual-level data from three large carotid endarterectomy studies.
• To conduct a systematic review and meta-analysis of published outcomes stratified by surgical side.

Main Methods:

• Pooled analysis of individual patient data from the WCCE, NASCET, and ACE trials.
• Systematic literature search of Medline and EMBASE for studies reporting CE outcomes by side.
• Fixed-effects meta-analysis to determine overall risk ratios for adverse events.

Main Results:

• Pooled analysis of NASCET and ACE trials showed significantly higher stroke or death rates for left-sided CE (5.39% vs. 2.96%, P<0.001).
• Risk-adjusted rate ratios for left- versus right-sided surgery were 1.22 for WCCE and 1.82 for pooled NASCET/ACE.
• Meta-analysis of all five studies yielded a pooled rate ratio for stroke or death of 1.36 (95% CI, 1.18 to 1.56).

Conclusions:

• Left-sided carotid endarterectomy is consistently associated with higher rates of postoperative adverse events.
• The observed disparities necessitate further investigation into the underlying mechanisms.
• Understanding these mechanisms is crucial for improving patient safety and outcomes in CE procedures.