Risk Factors For Stroke, Myocardial Infarction, or Death Following Carotid Endarterectomy: Results From the
D Doig1, E L Turner2, J Dobson3
1Institute of Neurology, University College London, UK.
Insights
High diastolic blood pressure is the sole independent risk factor for stroke, myocardial infarction, or death after carotid endarterectomy (CEA). Controlling blood pressure pre-procedure can mitigate these risks.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Neurology
Background:
- Carotid endarterectomy (CEA) is a standard procedure for symptomatic carotid artery stenosis.
- CEA carries inherent risks of stroke, myocardial infarction (MI), or death within 30 days.
- Identifying risk factors is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate risk factors for 30-day procedural complications following CEA.
- To analyze data from the International Carotid Stenting Study (ICSS) for patients undergoing CEA.
- To identify predictors of stroke, MI, or death post-CEA.
Main Methods:
- Analysis of 821 patients from the ICSS assigned to CEA.
- Prospective data collection on stroke, MI, or death within 30 days.
- Sequential and multivariable regression analysis of demographic and technical risk factors.
Main Results:
- The overall risk of stroke, MI, or death within 30 days of CEA was 4.0%.
- Higher risk observed in female patients (RR 1.98) and with increasing diastolic blood pressure (dBP) (RR 1.30 per 10 mmHg).
- Only elevated baseline diastolic blood pressure (mean 78 mmHg) remained a significant independent predictor in multivariable analysis.
Conclusions:
- Elevated diastolic blood pressure is the only independent risk factor for adverse events after CEA.
- Careful blood pressure management in patients with symptomatic carotid stenosis may reduce CEA-related risks.
- Post-procedure care, including monitoring after discharge, is important as 21.2% of events occurred post-discharge.
Objectives:
Carotid endarterectomy (CEA) is standard treatment for symptomatic carotid artery stenosis but carries a risk of stroke, myocardial infarction (MI), or death. This study investigated risk factors for these procedural complications occurring within 30 days of endarterectomy in the International Carotid Stenting Study (ICSS).
Methods:
Patients with recently symptomatic carotid stenosis >50% were randomly allocated to endarterectomy or stenting. Analysis is reported of patients in ICSS assigned to endarterectomy and limited to those in whom CEA was initiated. The occurrence of stroke, MI, or death within 30 days of the procedure was reported by investigators and adjudicated. Demographic and technical risk factors for these complications were analysed sequentially in a binomial regression analysis and subsequently in a multivariable model.
Results:
Eight-hundred and twenty-one patients were included in the analysis. The risk of stroke, MI, or death within 30 days of CEA was 4.0%. The risk was higher in female patients (risk ratio [RR] 1.98, 95% CI 1.02-3.87, p = .05) and with increasing baseline diastolic blood pressure (dBP) (RR 1.30 per +10 mmHg, 95% CI 1.02-1.66, p = .04). Mean baseline dBP, obtained at the time of randomization in the trial, was 78 mmHg (SD 13 mmHg). In a multivariable model, only dBP remained a significant predictor. The risk was not related to the type of surgical reconstruction, anaesthetic technique, or perioperative medication regimen. Patients undergoing CEA stayed a median of 4 days before discharge, and 21.2% of events occurred on or after the day of discharge.
Conclusions:
Increasing diastolic blood pressure was the only independent risk factor for stroke, MI, or death following CEA. Cautious attention to blood pressure control following symptoms attributable to carotid stenosis could reduce the risks associated with subsequent CEA.
More Related Videos
09:11Performing Permanent Distal Middle Cerebral with Common Carotid Artery Occlusion in Aged Rats to Study Cortical Ischemia with Sustained Disability
Published on: February 23, 2016
14:53Intra-Arterial Delivery of Neural Stem Cells to the Rat and Mouse Brain: Application to Cerebral Ischemia
Published on: June 26, 2020
Related Concept Videos
01:30Coronary Artery Disease I: Introduction
01:22Aneurysm IV: Nursing Management
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...
01:26Coronary Artery Disease IV: Preventive Measures
01:26Arteries of the Head and Neck
The internal carotid arteries supply blood to the anterior portion of the cerebrum. They enter the...