Intraoperative Completion Studies and Their Associations With Carotid Endarterectomy Outcomes

This study aimed at assessing outcomes after carotid endarterectomy (CEA) in dependence of center policy with respect to imaging intraoperative completion study (ICS i ) usage.

Although randomized controlled studies are missing, a beneficial effect was shown for ICS i techniques (ie, angiography and intraoperative duplex ultrasound) after CEA.

This secondary data analysis is based on the German statutory quality assurance database. The research was funded by Germany's Federal Joint Committee Innovation Fund (G-BA Innovationsfonds, 01VSF19016 ISAR-IQ). According to their ICS i policy, hospitals were categorized as routine ICS i (>90%), selective ICS i (10%-90%), or sporadic ICS i (<10%) centers. Primary study outcome was in-hospital stroke or death. Multivariable regression analyses were performed.

Between 2012 and 2016, a total of 119,800 patients underwent CEA. In-hospital stroke or death rates were lower in routine ICS i centers (1.7%) compared with selective (2.1%) and sporadic ICS i centers (2.0%). The multivariable regression analysis showed, that in routine ICS i centers, ICS i use was associated with lower rates of stroke or death (adjusted odds ratio: 0.64; 95% CI: 0.44-0.93). In selective ICS i centers, ICS i was not associated with the occurrence of either of the assessed outcomes. In sporadic ICS i centers, ICS i was associated with higher rates of stroke or death (adjusted odds ratio: 1.91; 95% CI: 1.26-2.91).

Lowest in-hospital stroke or death rates are achieved in routine ICS i centers. Although ICS i is associated with a lower perioperative risk in routine ICS i centers, it might act as a surrogate marker for worse outcomes due to intraoperative irregularities in sporadic ICS i centers. Routine use of ICS i is advisable.