Poor Neurological Deficit Was an Independent 30-day Risk Factor in Symptomatic Carotid Stenosis after CEA with
Faliang Gao1, Wenyan Zhao2, Cheng Wu1
1Department of Neurosurgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China.
Insights
Poor neurological deficit significantly increases the 30-day risk of major adverse cardiovascular events (MACEs) after carotid endarterectomy (CEA). Surgeons should carefully consider this risk when deciding on CEA for symptomatic carotid stenosis.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Neurology
Background:
- Carotid endarterectomy (CEA) is crucial for stroke prevention.
- Efficacy relies on managing perioperative risk factors.
- Preoperative neurological deficit is a key risk factor.
Purpose of the Study:
- To analyze the association between preoperative neurological deficit and 30-day MACEs risk.
- To evaluate CEA with selective shunting in symptomatic carotid stenosis.
- To identify risk factors for perioperative MACEs.
Main Methods:
- Assessed 653 patients undergoing CEA with selective shunting.
- Defined MACEs as stroke, mortality, or myocardial infarction within 30 days.
- Used multivariable logistic regression to assess modified Rankin Scale (mRS) and MACEs risk.
Main Results:
- 30-day MACEs rate was 2.5%.
- Poor neurological deficit (mRS ≥ 3) was independently associated with higher MACEs risk (adjusted OR 5.70).
- Coronary artery disease and severe contralateral stenosis also increased MACEs risk.
Conclusions:
- Poor neurological deficit is an independent predictor of 30-day MACEs after CEA.
- Findings guide surgical decisions for patients with neurological deficits.
- Careful consideration is needed before performing CEA in these patients.
Background:
Carotid endarterectomy (CEA) prevents the occurrence of stroke in the future, although its efficacy depends on the detection and control of high perioperative risk factors. We aimed to analyze the association between preoperative neurological deficit and the 30-day risk of major adverse cardiovascular events (MACEs) in CEA with selective shunting for symptomatic carotid stenosis.
Methods:
We assessed 653 patients who underwent CEA with selective shunting for symptomatic carotid stenosis between August 2011 and August 2019. The primary outcomes of the study were the occurrence of MACEs, defined as stroke (ischemic stroke or cerebral hemorrhage), all-cause mortality, and myocardial infarction during the perioperative period after CEA. Baseline patient characteristics were analyzed to identify factors associated with perioperative (<30 days) MACEs. Multivariable logistic regression models were used to estimate the association between preoperative modified Rankin Scale (mRS) and the 30-day risk of MACEs. Interaction and stratified analyses were conducted according to age, drinking, history of hypertension and coronary artery disease, and surgical side.
Results:
The mean age of patients was 68.7 ± 9.1 years, and 86.4% were men. The 30-day MACEs rate was 2.5%. In univariate logistic regression, histories of coronary artery disease (odds ratio (OR), 2.57 [95% confidence interval (CI), 1.04-6.34]), a severe contralateral carotid stenosis or occlusion (OR, 4.52 [95% CI, 1.84-11.11]), and a poor neurological deficit (mRS ≥ 3 versus mRS < 3: OR, 3.78 [95% CI, 1.21-11.82]) were associated with higher primary outcome rates. A history of hypertension did not increase the risk of MACEs (OR, 0.37 [95% CI, 0.15-0.89]). In the multivariable regression analysis, poor neurological deficit was associated with a higher risk of the MACEs within 30 days (mRS ≥ 3 versus mRS < 3: 11.1% vs. 2.0%, adjusted OR 5.70 [95% CI, 1.50-21.60]). The interaction analysis revealed no interactive role in the association between neurological deficit and 30-day risk of MACEs.
Conclusions:
Poor neurological deficit was an independent risk factor associated with the 30-day risk of MACEs in symptomatic patients who underwent CEA with selective shunting. Our findings may provide guidance to surgeons when treating patients with poor neurological deficit. The decision to perform surgery should be made after careful consideration.
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