Related Experiment Videos
Identifying risk factors and proposing a risk-profile scoring scale for perioperative ischemic complications in
Pantelis Stavrinou1, Julian Bergmann, Stefan Palkowiz
1Department Department of Neurosurgery, University of Cologne, Germany - pantelis.stavrinou@uk-koeln.de.
Insights
Carotid endarterectomy is safe in low-volume centers, but certain risk factors increase stroke complications. A new scoring system helps identify high-risk patients for this stroke prevention surgery.
Area of Science:
- Vascular Surgery
- Neurosurgery
- Stroke Prevention
Background:
- Carotid endarterectomy (CEA) reduces stroke risk in severe symptomatic carotid artery stenosis.
- Perioperative ischemic complications significantly influence CEA's benefit.
- Assessing safety and risk factors in low-volume centers is crucial.
Purpose of the Study:
- Evaluate the safety of CEA in a low-volume neurosurgical department.
- Identify risk factors associated with perioperative ischemic events after CEA.
- Develop a scoring system to stratify patient risk.
Main Methods:
- Retrospective review of 218 CEAs performed over ten years.
- Data abstraction included demographics, neurologic history, stenosis degree, comorbidities, and complications.
- Analysis focused on identifying predictors of perioperative ischemic events.
Main Results:
- Zero mortality; 5.5% experienced perioperative ischemic events (12 patients).
- Risk factors for complications included prior stroke, contralateral stenosis, diabetes, hypercholesterolemia, and hypertriglyceridemia.
- A developed scoring system effectively stratified patients into low, medium, and high-risk groups.
Conclusions:
- CEA can be performed safely in low-volume centers.
- History of stroke, contralateral carotid stenosis, and multiple atherosclerotic factors indicate higher risk.
- The developed scoring system aids in risk-benefit assessment for individual patients.
Background:
Carotid endarterectomy can reduce the risk of stroke in patients with severe symptomatic carotid artery stenosis, but the benefit of the procedure can be significantly influenced by the risk of perioperative ischemic complications. We conducted a retrospective study in order to assess the safety of the procedure in a low-volume single Neurosurgical Department and identify potential risk factors that are associated with the occurrence of a perioperative ischemic event.
Methods:
The records of 218 procedures performed over a period of ten years were reviewed. The records were abstracted for demographics, neurologic history, degree of stenosis, comorbidities and ischemic complications within 30 days of surgery.
Results:
The overall mortality was zero but 12 patients (5.5%) suffered from a perioperative ischemic event, half of which were non-reversible; four of them had a complete stroke and 2 an amaurosis. A postoperative ischemic complication was more likely for patients with a history of complete stroke (RR, 5.93; 95% CI, 1.7-23.0), contralateral vessel stenosis (RR, 11.6; 95% CI, 1.6-244.0), diabetes mellitus (RR: 3.3; 95% CI: 1.13-10.09), hypercholesterolemia (RR: 3.4; 95% CI: 1.13-10.44) and hypertriglyceridemia (RR: 4.6; 95% CI: 1.31-12.42). Using these factors we created a scoring system that stratifies patients into low, medium and high risk. All but two of the patients with perioperative ischemic events fall into the high risk group. Patients with the aforementioned risk factors may have an elevated risk of adverse outcomes.
Conclusions:
Carotid endarterectomies can be performed with exceptional safety in low-volume-centers, but patients with a history of stroke, contralateral internal carotid artery stenosis and three or more atherosclerotic factors are at a higher risk of perioperative ischemic complications. Our scoring system could prove a valuable tool when weighting the risk-to-benefit ratio for an individual patient.