Severe contralateral carotid stenosis or occlusion drive 30-day risk after carotid endarterectomy
Wenyan Zhao1, Faliang Gao2, Cheng Wu2
1General Practice Department, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China.
Insights
Patients with severe contralateral carotid stenosis or occlusion (SCSO) face a significantly higher risk of major adverse events after carotid endarterectomy. Careful consideration is needed for SCSO patients undergoing this surgery.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Neurosurgery
Background:
- Carotid endarterectomy is a recognized treatment for severe carotid stenosis.
- The benefit of carotid endarterectomy in patients with severe contralateral carotid stenosis or occlusion (SCSO) remains controversial.
- Selective shunting is employed during the procedure.
Purpose of the Study:
- To evaluate the impact of SCSO on early outcomes following carotid endarterectomy with selective shunting.
- To determine if SCSO is an independent predictor of perioperative major adverse events.
Main Methods:
- Analysis of 617 patients undergoing carotid endarterectomy with selective shunting (August 2011-October 2019).
- SCSO defined as >70% stenosis or occlusion of the contralateral carotid artery.
- Comparison of major adverse events (stroke, mortality, myocardial infarction) between SCSO (n=116) and non-SCSO groups using multivariable and propensity score-adjusted logistic regression.
Main Results:
- The overall 30-day major adverse events rate was 2.5%.
- The SCSO group exhibited a significantly higher rate of major adverse events (9.5%) compared to the non-SCSO group (1.6%) (p < 0.001).
- SCSO was associated with an increased risk of major adverse events (aOR 5.05 in multivariable analysis, aOR 3.78 in propensity score analysis).
Conclusions:
- Severe contralateral carotid stenosis or occlusion (SCSO) is an independent predictor of 30-day major adverse events after carotid endarterectomy.
- The suitability of carotid endarterectomy for patients with SCSO requires careful clinical consideration.
- Further research may be needed to optimize management strategies for these high-risk patients.
Objectives:
The significant effects on the treatment of severe carotid stenosis by carotid endarterectomy have been widely recognized. However, it is controversial whether patients with severe contralateral carotid stenosis or occlusion (SCSO) can benefit from carotid endarterectomy surgery. This study aimed to estimate the SCSO effects on early outcomes after carotid endarterectomy with selective shunting.
Methods:
Between August 2011 and October 2019, a total of 617 patients who underwent carotid endarterectomy with selective shunting were analyzed. SCSO was defined as >70% luminal narrowing of the contralateral extracranial carotid stenosis or occlusion. Of these patients, 116 were categorized into an SCSO group while the rest were assigned to the non-SCSO group. Primary study outcomes were the occurrence of major adverse events, defined as stroke, all-cause mortality, and myocardial infarction during the perioperative period after carotid endarterectomy. Traditional multivariable logistic regression model and logistic regression model adjusted for propensity scores were used to estimate the SCSO effects on primary outcomes. Interaction and stratified analyses were conducted according to age, sex, comorbidities (hypertension, diabetes), preoperative neurological deficit, preoperative symptoms, and shunt use.
Results:
Mean age was 68.5 ± 9.2 years (86.1% men). Overall major adverse events rate within 30 days was 2.5%. Major adverse events rates in SCSO and non-SCSO groups were 9.5% and 1.6%, respectively. This difference was statistically significant (p < 0.001). In multivariable regression analysis, patients with SCSO had a higher risk of major adverse events (non-SCSO vs. SCSO: aOR 5.05 [95% CI, 1.78-14.55]). In 342 propensity score matched patients, results were consistent (propensity score: aOR, 3.78 [95% CI, 1.13-12.64]).
Conclusions:
SCSO is an independent predictor of 30-day major adverse events. Whether these patients with SCSO are suitable for carotid endarterectomy should be carefully considered.
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