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Carotid artery surgery: high-risk patients or high-risk centers?
Zakariyae Bouziane1, Ghislain Nourissat, Ambroise Duprey
1Department of vascular surgery, St Etienne University Hospital, St Etienne, France. zakibouzi@yahoo.fr
Insights
Carotid endarterectomy (CEA) is safe for high-risk patients. Factors like comorbidities or lesion location do not increase complications and should not exclude patients from CEA.
Area of Science:
- Vascular Surgery
- Cerebrovascular Disease Management
Background:
- Carotid angioplasty and stenting (CAS) is an alternative to carotid endarterectomy (CEA).
- Established criteria for identifying high-risk patients for CEA are lacking.
- This study evaluates factors potentially indicating high risk for CEA.
Purpose of the Study:
- To assess the impact of supposed high-risk factors on early postoperative outcomes of CEA.
- To determine if specific patient characteristics should be exclusion criteria for CEA.
Main Methods:
- Retrospective review of 1,033 consecutive CEAs over 5.6 years.
- Analysis of early mortality and neurologic events (stroke, myocardial infarction).
- Univariate and multivariate analyses considered age, sex, comorbidities, symptoms, and anatomy.
Main Results:
- Cumulative 30-day stroke and death rate was 1.2%.
- Symptomatic carotid artery disease significantly increased postoperative stroke risk (2.6%, P=0.004).
- No statistically significant impact on 30-day outcomes was found for other analyzed variables.
Conclusions:
- Significant medical comorbidities, contralateral carotid occlusion, and high carotid lesions do not increase CEA complications.
- These factors should not be used as exclusion criteria for carotid endarterectomy.
Background:
Carotid angioplasty and stenting has been proposed as an alternative to carotid endarterectomy (CEA) in patients deemed as at high risk for this surgical procedure. To date, definitely accepted criteria to identify "high-risk" patients for CEA do not exist. Our objective was to assess the relevance of numerous supposed high-risk factors in our experience, as well as their possible effect on our early postoperative results.
Methods:
A retrospective review of 1,033 consecutive CEAs performed during a 5.6-year period at a single institution was conducted (Vascular Surgery Department, St. Etienne University Hospital, France). Early results in terms of mortality and neurologic events were recorded. Univariate and multivariate analyses for early risk of stroke, myocardial infarction, and death were performed, considering the influence of age, sex, comorbidities, clinical symptoms, and anatomic features.
Results:
The cumulative 30-day stroke and death rate was 1.2%. A total of 10 strokes occurred and resulted in three deaths. The postoperative stroke risk was significantly higher in the subgroup of patients treated for symptomatic carotid artery disease: 2,6% (P = 0,004). Univariate analysis and logistic regression did not show statistical significance for 30-day results in any of the considered variables.
Conclusion:
Patients with significant medical comorbidities, contralateral carotid occlusion, and high carotid lesions can undergo surgery without increased complications. Those parameters should not be used as exclusion criteria for CEA.
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