[Risk of stroke and death after carotid endarterectomy]
Auksė Meškauskienė1, Egidijus Barkauskas, Virginija Gaigalaitė
1Center of Neurology and Nerosurgery, Clinic of Neurovascular Surgery, Vilnius University Hospital Santariškių Klinikos, Santariškių 2, Vilnius, Lithuania. aukselis1@hotmail.com
Insights
Carotid endarterectomy outcomes depend on patient factors and surgeon experience. Diabetes, prior stroke, and low surgeon volume predict poor results, highlighting the need for careful patient selection and experienced surgeons.
Area of Science:
- Vascular Surgery
- Neurosurgery
- Public Health
Context:
- Carotid endarterectomy (CEA) is a crucial procedure for stroke prevention.
- Patient outcomes after CEA are significantly influenced by surgical risk factors.
- Evaluating surgeon competence and patient comorbidities is vital for optimizing CEA results.
Purpose:
- To assess stroke and death rates following CEA.
- To identify risk factors associated with adverse outcomes.
- To determine the impact of surgeon experience and volume on CEA results.
Summary:
- A retrospective analysis of 790 CEAs revealed in-hospital mortality of 2.2% and stroke morbidity of 2.4%.
- Diabetes mellitus, a history of stroke, and low surgeon volume (performing <6 CEAs/year) were independently associated with increased mortality and stroke risk.
- Higher stroke rates were observed in patients with diabetes (12% vs. 3.4%) and those with prior stroke (10.7% vs. 1.4%).
Impact:
- Identifies diabetes mellitus, prior stroke, and low surgeon volume as key predictors of poor outcomes in CEA.
- Emphasizes the importance of surgeon experience and patient selection for improving CEA safety and efficacy.
- Provides data to inform clinical decision-making and quality improvement initiatives in cerebrovascular surgery.
Objective:
The benefit of carotid endarterectomy is highly dependent on surgical risk. The aim of this study was to evaluate the incidence of stroke and death after carotid endarterectomy, risk factors for poor outcomes, and importance of surgeon's competence.
Material And Methods:
A total of 790 carotid endarterectomies performed in the Vilnius University Emergency Hospital between 1995 and 2006 were analyzed. Risk factors, neurological symptoms, comorbidities, radiologic and angiographic findings, morbidity and mortality, experience and volume of a vascular surgeon were prospectively recorded in a database. Univariate and multivariable logistic regression and receiver operating characteristic curves were used to analyze the data.
Results:
Among the 790 cases studied, in-hospital mortality was 2.2%, and stroke morbidity was 2.4%. Postoperative complications were more common in patients with diabetes mellitus than without (12% vs. 3.4%, P<0.001) and in patients with any stroke than in patients with nonspecific symptoms (10.7% vs. 1.4%, P<0.02). The postoperative stroke rate was 10% for a surgeon who performed <6 carotid endarterectomies per year and 4.6% for a surgeon who performed ≥6 carotid endarterectomies (P=0.02). In the multivariate logistic regression, combined mortality and stroke was independently predicted by diabetes mellitus (OR, 3.51; 95% CI, 1.60-7.66; P=0.002), any stroke (OR, 4.14; 95% CI, 1.57-10.91; P=0.004), and low-volume surgeon (OR, 0.32; 95% CI, 0.13-0.78; P=0.013). The receiver operating characteristic curve analysis showed an overall predicting value of 0.72.
Conclusions:
Diabetes mellitus, any stroke, and low-volume vascular surgeon were significant predictors for poor outcome after carotid endarterectomy.
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