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Carotid Endarterectomy: A Single Institutional Experience of 28 Years From Pakistan
Mohammad Mussadiq Khan1, Hadi Mohammad Khan1, Usama Khalid Choudry1
1Department of General and Vascular Surgery, Shifa International Hospital, Islamabad, Pakistan.
Insights
Carotid endarterectomy (CEA) is a safe and effective procedure for preventing stroke in patients with carotid stenosis. This study in Pakistan shows low complication rates and good long-term outcomes.
Area of Science:
- Vascular Surgery
- Neurology
- Public Health
Background:
- Cerebrovascular events are a leading cause of acute neurological injury globally.
- Limited data exists on the safety and efficacy of interventions for cerebrovascular disease in South Asia.
Background:
Cerebrovascular event is the most common reason of acute neurological injury in the western world. There is an extensive literature and data available on its prognosis, outcomes and complications rates from the west, yet still, data regarding its safety and efficacy is scarce from the South Asian belt.
Objective:
To elucidate the role of carotid endarterectomy in patients with carotid stenosis regarding prevention of stroke and safety of the procedure.
Methods:
A descriptive case series of 335 consecutive patients from January 1990 till July 2018. All patients who underwent carotid endarterectomy were included. Patient having asymptomatic carotid disease (≥90%), history of a transient ischemic attack or patients with a recent or previous episode of ischemic stroke (≥60%) were selected for the procedure. All procedures were performed under GA. Post operatively patients were kept on antiplatelet therapy and followed on outpatient basis for any complications using carotid duplex scans. Data regarding 30-day postoperative parameters of the procedure were collected and evaluated. P< 0.05 is considered significant.
Results:
A total of 335 carotid endarterectomies were performed. The majority of patients in our series were males 68.90% (n = 230) compared to 31.10% (n = 105) females (P< 0.05). There were no intraoperative mortalities in our patients. The 15-day perioperative mortality was 1.5% (n = 5), out of which 3 patients had concomitant CABG and died of cardiac complications. The mortality rate of CEA alone was 0.6% (n = 2). Six patients (1.8%) developed focal neurological deficits in the postoperative period during the hospital stay. Three patients developed wound infection after surgery. Neck hematoma formation occurred in 11.7% (n = 39) patients and 7 required immediate decompression. A total of 321 patients remained stroke free at 6 months follow up. There was no increased risk of stroke secondary to bilateral carotid disease (OR 1.9 CI 0.35-10.7 P= 0.44).
Conclusion:
Carotid Endarterectomy is a relatively safe and effective procedure in our large series from Pakistan. It remains the standard for management of carotid stenosis in symptomatic as well as asymptomatic patients with critical stenosis.