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A study of carotid endarterectomy in a Chinese population: initial experience at a single center
Yanfei Chen1, Gang Song1, Liqun Jiao1
1Department of Neurosurgery, Xuan Wu Hospital, Capital Medical University, Beijing 10053, China.
Insights
Carotid endarterectomy effectively treats carotid artery stenosis, reducing stroke risk. Female gender, smoking, and severe neurological deficits independently increase perioperative stroke and death risks.
Area of Science:
- Vascular Surgery
- Neurology
- Public Health
Background:
- Carotid artery stenosis is a significant cause of ischemic stroke.
- Carotid endarterectomy (CEA) is a primary surgical intervention for preventing stroke in symptomatic patients.
- Evaluating the safety and efficacy of CEA in diverse populations is crucial for optimizing patient outcomes.
Purpose of the Study:
- To assess the initial outcomes of carotid endarterectomy (CEA) in a Chinese patient cohort.
- To identify risk factors associated with perioperative stroke and death following CEA.
- To evaluate the long-term efficacy of CEA in preventing stroke recurrence.
Main Methods:
- Retrospective review of 433 patients undergoing CEA at Xuan Wu Hospital (2001-2012).
- Analysis of 30-day postoperative complications, including stroke, death, cranial nerve injury, and cardiac events.
- Univariate and multivariate logistic regression to determine factors influencing perioperative stroke and death.
Main Results:
- Overall 30-day complication rates were 4.08% for death/stroke, 3.63% for cranial nerve injuries, and 3.63% for cardiac complications.
- Female gender, current smoking, and a modified Rankin Scale (mRS) score ≥ 3 were identified as independent risk factors for perioperative stroke and death.
- Restenosis occurred in 11 cases (2.54%), with two symptomatic events during a mean follow-up of 32.99 months.
Conclusions:
- Carotid endarterectomy is an effective procedure for preventing and treating stroke caused by carotid artery stenosis in this Chinese population.
- Pre-existing neurological deficits (mRS ≥ 3), female sex, and active smoking are significant risk factors for adverse outcomes post-CEA.
- Continued monitoring and risk factor modification are essential for patients undergoing CEA.
Objective:
This retrospective study aimed to evaluate our initial experience with carotid endarterectomy in a Chinese population.
Methods:
Four hundred and thirty-three patients who underwent carotid endarterectomies at Xuan Wu Hospital Capital Medical University between January 1, 2001, and December 31, 2012, were reviewed. The postoperative 30-day complications were analyzed. Univariate and multivariate logistic regression analyses were used to analyze the factors associated with perioperative stroke and death.
Results:
The overall 30-day complication rates after surgery were 4.08% for death and stroke, 3.63% for cranial nerve injuries, and 3.63% for heart complications. The mean follow-up time was 32.99 months, and only 11 cases required restenosis, including two that were symptomatic (experiencing transient ischemic attacks). In the univariate analysis, a history of cerebral infarction was present preoperatively in 179 patients, of whom 12 (6.70%) had a postoperative stroke or died (P=0.021). Thirty-two patients had a modified Ranking score (mRS)≥ 3, and six (18.75%) of these patients had a postoperative stroke or died (P<0.001). In the multivariate logistic regression, female gender (OR: 4.669; 95% CI: 1.238-17.602; P=0.023), current smoking habits (OR: 3.826; 95% CI: 1.298-11.277; P=0.015), and an mRS ≥ 3 (OR: 1.540; 95% CI: 3.844-40.909; P<0.001) were independent risk factors for perioperative stroke and death.
Conclusions:
In our single-center study, carotid endarterectomies appeared to effectively prevent and treat the carotid artery stenosis that leads to stroke. Female gender, current smoking habits, and neurological deficits (mRS ≥ 3) increased the perioperative stroke and death rates.
