Perioperative results eversion carotid endarterectomy in bilateral symptomatic stenosis
Muhamed Djedovic1, Samed Djedovic2, Nedzad Rustempasic1
1Clinic for vascular surgery, Clinical Center of University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
Insights
Carotid endarterectomy (CEA) is safe for patients with symptomatic internal carotid artery stenosis, even with contralateral stenosis. This study found no significant difference in perioperative complications for CEA in patients with unilateral or bilateral stenosis.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiology
Background:
- Carotid endarterectomy (CEA) is a standard stroke prevention treatment for significant internal carotid artery stenosis.
- Eversion endarterectomy is indicated for symptomatic stenosis (70-99%) and suitable for contralateral stenosis (50-70%).
Purpose of the Study:
- To evaluate perioperative complications (stroke, TIA, MI, mortality) after carotid eversion endarterectomy.
- Compare outcomes in patients with unilateral versus bilateral symptomatic internal carotid artery stenosis.
Main Methods:
- 139 patients with symptomatic carotid artery stenosis were divided into two groups: bilateral stenosis (Group A, n=74) and unilateral stenosis (Group B, n=65).
- Group A had internal carotid artery stenosis ≥70% with contralateral stenosis of 50-70%. Group B had unilateral stenosis ≥70%.
Main Results:
- Demographics showed no significant differences between groups regarding age, sex, or risk factors like smoking, hypertension, statin use, diabetes, or heart disease.
- Perioperative complications (stroke, TIA, MI, mortality) were not statistically different between the bilateral and unilateral stenosis groups.
Conclusions:
- Carotid eversion endarterectomy demonstrates an acceptable risk profile for patients with symptomatic internal carotid artery stenosis, including those with contralateral stenosis of 50-70%.
- No significant differences in perioperative complications were observed between patients treated for unilateral or bilateral symptomatic stenosis.
Introduction:
Carotid endarterectomy (CEA) is a standard treatment for the prevention of stroke and death in patients with significant stenosis of the internal carotid artery. Eversion endarterectomy is warranted in patients with symptoms of cerebral ischemia and the degree of stenosis of 70-99%. The same is suitable for treating a symptomatic carotid artery stenosis with contralateral stenosis (50-70%).
Purpose:
The aim of this study was to evaluate perioperative complications (ICV, TIA, MI, mortality) in patients treated with carotid eversion endarterectomy with unilateral and bilateral symptomatic stenosis (with bilateral stenosis treated with ACI stenosis ≥70%).
Patients And Methods:
The study included 139 patients with symptomatic carotid artery stenosis at the Department of Vascular Surgery of the University Clinical Center of Sarajevo in the period from January 2012 to December 2014 year. Given the involvement of ACI stenosis patients were divided into two groups. Group A consisted of 74 patients with bilateral stenosis (surgically treated with ACI stenosis ≥70%, while the degree of stenosis opposite ACI was from 50-70%), and group B of 65 patients with unilateral stenosis ≥70%.
Results:
Of the 139 patients included in the study, in the group A was 74, of which 46 male (62.2%) and 28 female (37.8%), while in group B were 42 male (64.6%) and 23 female (35.4%) (p = 0.90). The subjects in group A were slightly older 65.9 (± 7.8) compared to group B 64.2 (± 7.7) (p = 0.17). Analysis of risk factors indicating a higher number in Group A compared to group B, but the difference was not statistically significant: 34 smokers (45.9%) versus 36 (55.4%); p = 0:34), patients with hypertension (63 (85.1%) against the 52 (80.0%); p = 0.56), with statin therapy (62 (83.8%) versus 52 (80.0%); p = 0.72), diabetes (18 (24.3%) versus 18 (27.7%); p = 0.79) and with a heart disease (18 (24.3%) versus 7 (10.8%); p = 0.06). Analysis of the frequency of perioperative complications between the groups was not statistically significant: ICV (2/74 versus 3/65; p = 1.00), TIA (2/74 versus 3/65; p = 0.88), one death was recorded in group A, while myocardial infarction (MI) we had in either group.
Conclusion:
In this study, no statistically about significant differences in the number of perioperative complications (from 0 to 30 days) between the two groups. With this risk is acceptable to perform carotid endarterectomy in a patient in the opposite ACI stenosis of 50-70%.
