Variability in carotid endarterectomy practice patterns within a metropolitan area.
Amit Kansara1, Daniel Miller, Rahul Damani
1Department of Neurology, Wayne State University, Henry Ford Hospital, 8-C-UHC, 4201 St Antoine, Detroit, MI 48201, USA.
Stroke
|August 31, 2012
Summary
Carotid endarterectomy is often performed in high-risk patients, despite a doubled complication rate. Multidisciplinary conferences may improve patient selection and safety for carotid stenosis treatment.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurosurgery
Background:
- Previous studies suggest carotid artery stenting or medical therapy may be better for high-risk carotid stenosis patients.
- The current practice patterns for carotid endarterectomy in high-risk individuals are not well-defined.
Purpose of the Study:
- To evaluate the proportion of high surgical risk patients undergoing carotid endarterectomy.
- To compare complication rates between conventional and high surgical risk patients undergoing carotid endarterectomy.
Main Methods:
- Retrospective audit of 335 carotid endarterectomies across 4 hospitals over 2 years.
- Comparison of in-hospital stroke, myocardial infarction, and death rates.
- Analysis of patient risk stratification and procedural outcomes.
Main Results:
- 37.9% of carotid endarterectomies were performed in high surgical risk patients.
- High surgical risk patients had a 2-fold increase in major in-hospital complications (10.2% vs 4.6%).
- The hospital with multidisciplinary carotid conferences performed fewer procedures on asymptomatic patients.
Conclusions:
- A significant number of carotid endarterectomies are performed on high-risk patients, with increased complications.
- The benefit of carotid endarterectomy in high-risk patients is questionable.
- Preintervention multidisciplinary conferences may enhance patient safety and optimize treatment selection.