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Is diabetes a marker of higher risk after carotid revascularization? Experience from a single centre
Renato Casana1,2, Chiara Malloggi2, Andrea Odero1
11 Department of Surgery, IRCCS Istituto Auxologico Italiano, Milan, Italy.
Insights
Diabetes increases periprocedural risks for stroke or death after carotid revascularization. While long-term outcomes are similar, diabetes patients face higher restenosis rates following carotid artery stenting or endarterectomy.
Area of Science:
- Vascular Surgery
- Diabetology
- Cardiovascular Research
Background:
- Diabetes mellitus is a prevalent comorbidity impacting cardiovascular health.
- Carotid revascularization procedures, including endarterectomy and stenting, are crucial for stroke prevention.
- Understanding the influence of diabetes on these procedures is vital for patient management.
Purpose of the Study:
- To investigate the impact of diabetes mellitus on outcomes after carotid artery endarterectomy or stenting.
- To compare periprocedural and long-term results in diabetic versus non-diabetic patients undergoing carotid revascularization.
Main Methods:
- A single-center study analyzing 752 carotid revascularizations (58.2% stenting, 41.8% endarterectomy).
- Patients were stratified into diabetic (29.4%) and non-diabetic (70.6%) groups.
- Outcomes assessed included death, stroke (disabling/non-disabling), transient ischemic attack, and restenosis within 36 months.
Main Results:
- Diabetic patients exhibited higher periprocedural risks of stroke or death (3.6% vs 0.6%) and restenosis (2.7% vs 0.6%).
- No significant long-term differences in death, stroke, or transient ischemic attack rates were observed between groups.
- However, diabetic patients showed significantly higher 36-month restenosis rates (21.2% vs 12.5%).
Conclusions:
- Diabetes mellitus is associated with increased periprocedural risks in carotid revascularization.
- Long-term risks for death, stroke, and transient ischemic attack do not significantly differ between diabetic and non-diabetic patients.
- Restenosis remains a higher long-term concern for diabetic patients post-carotid revascularization.
Purpose:
This single centre study investigates the influence of diabetes mellitus on outcomes following carotid artery endarterectomy or stenting.
Methods:
In total, 752 carotid revascularizations (58.2% carotid artery stenting and 41.8% carotid endarterectomy) were performed in 221 (29.4%) patients with diabetes and 532 (70.6%) patients without diabetes. The study outcomes were death, disabling and non-disabling stroke, transient ischaemic attack and restenosis within 36 months after the procedure.
Results:
Patients with diabetes had higher periprocedural risk of any stroke or death (3.6% diabetes vs 0.6% no diabetes; p < 0.05), transient ischaemic attack (1.8% diabetes vs 0.2% no diabetes; p > 0.05) and restenosis (2.7% diabetes vs 0.6% no diabetes; p < 0.05). During long-term follow-up, there were no significant differences in Kaplan-Meier estimates of freedom from death, any stroke and transient ischaemic attack, between people with and without diabetes for each carotid artery stenting and carotid endarterectomy subgroup. Patients with diabetes showed higher rates of restenosis during follow-up than patients without diabetes (36-months estimate risk of restenosis: 21.2% diabetes vs 12.5% no diabetes; p < 0.05).
Conclusion:
The presence of diabetes was associated with increased periprocedural risk, but no further additional risk emerged during longer term follow-up. Restenosis rates were higher among patients with diabetes.
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