Influence of chronic renal insufficiency on outcomes following carotid revascularization
Clinton D Protack1, Andrew M Bakken, Wael E Saad
1Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
Insights
Patients with severe renal insufficiency undergoing carotid revascularization face significantly higher 30-day mortality. Moderate renal insufficiency does not significantly impact outcomes, highlighting the importance of assessing kidney function before carotid procedures.
Area of Science:
- Vascular Surgery
- Nephrology
- Cardiovascular Medicine
Background:
- Carotid revascularization is crucial for stroke prevention.
- Chronic kidney disease (CKD) is increasingly prevalent in surgical populations.
- The impact of varying degrees of renal insufficiency on carotid revascularization outcomes requires detailed examination.
Purpose of the Study:
- To evaluate perioperative and long-term outcomes of carotid revascularization.
- To assess the influence of moderate to severe renal insufficiency on these outcomes.
Main Methods:
- Retrospective review of 921 carotid interventions (endarterectomy and angioplasty/stenting) from 1996-2006.
- Patients stratified by renal function using Modification of Diet in Renal Disease (MDRD) equation-derived Glomerular Filtration Rate (GFR).
- Groups: Stage 0-2 (GFR ≥60 mL/min/1.73m²), Stage 3 (GFR <60 and ≥30 mL/min/1.73m²), Stages 4-5 (GFR <30 mL/min/1.73m²).
Main Results:
- Overall 30-day mortality and morbidity were 1.1% and 16.9%.
- 6% of patients had severe renal insufficiency (Stages 4-5).
- Severe renal insufficiency was associated with significantly higher 30-day mortality (5.45% vs. 0.66% in normal function, P=.005). No significant difference in 30-day stroke rates across renal function groups (P=.54).
- Carotid endarterectomy showed no stroke difference based on renal function; severe insufficiency patients had lower stroke-free rates after angioplasty/stenting.
Conclusions:
- Chronic kidney disease is common in patients undergoing carotid revascularization.
- Moderate renal insufficiency generally yields similar outcomes to normal renal function.
- Severe renal insufficiency significantly increases 30-day mortality risk following carotid revascularization, particularly with stenting.
Objectives:
To examine the perioperative and long-term outcomes of patients undergoing carotid revascularization and to determine the influence moderate or severe renal insufficiency may have on these outcomes.
Design:
Retrospective database review.
Setting:
Academic tertiary hospital.
Patients:
Patients undergoing carotid endarterectomy and carotid angioplasty and stenting from 1996 to 2006.
Intervention:
Carotid revascularization.
Main Outcome Measure:
Glomerular filtration rate (GFR) was calculated based on the Modification of Diet in Renal Disease equation. Groups were analyzed by stages 0 to 2 (GFR ≥60 mL/min/1.73m(2)) vs stage 3 (GFR <60 and ≥30 mL/min/1.73m(2)) vs stages 4 and 5 (GFR <30 mL/min/1.73m(2)).
Results:
Nine hundred twenty-one carotid interventions were performed (750 carotid endarterectomy, 171 carotid angioplasty and stenting). The overall 30-day mortality and morbidity rates were 1.1% and 16.9%, respectively. Sixty-six percent of patients had normal renal function (stages 0-2). Twenty-eight percent of patients had moderate renal insufficiency (stage 3) and 6% of patients had severe renal insufficiency (stages 4-5). The 30-day stroke rates for groups were 2.98% (normal renal function), 2.67% (moderate renal insufficiency), and 5.45% (severe renal insufficiency) (P = .54). Thirty-day mortality rates between groups were 0.66% (normal renal function), 1.15% (moderate renal insufficiency), and 5.45% (severe renal insufficiency) (P = .005). For carotid endarterectomy, no difference in freedom from stroke existed based on level of renal function. For carotid angioplasty and stenting, patients with severe renal insufficiency exhibited significantly lower rates of freedom from stroke.
Conclusions:
Chronic kidney disease is prevalent among patients undergoing carotid revascularization. Overall, patients with moderate renal function have similar outcomes. However, those with severe renal insufficiency have significantly higher 30-day mortality when undergoing carotid revascularization.
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