Predictors of Late Adverse Outcomes After Carotid Endarterectomy

Background and Objectives: Although carotid endarterectomy (CEA) is the gold standard in the treatment of carotid disease, a higher frequency of adverse outcomes can reduce its benefit. The aim of the present study is to identify factors related to myocardial infarction, stroke, death and restenosis as the late adverse outcomes of CEA. Materials and Methods: The retrospective cohort study included 1597 CEAs that were performed in 1533 consecutive patients at the Vascular Surgery Clinic in Belgrade from 2012 to 2017. Late adverse outcomes within 4 years after CEA were available for the majority of them. Data for myocardial infarction and stroke were available for 1223 CEAs, data for death for 1305 CEAs, and data for restenosis for 1162 CEAs. The association between possible risk factors and late adverse outcomes of CEA was analyzed using univariate and multivariate Cox and logistic regression analyses. Results: During follow-up, myocardial infarction occurred after 55, stroke after 68, death after 103 and restenosis after 121 CEAs. Two factors were the most frequent predictors of late adverse outcomes, i.e., the patient's age and diabetes mellitus (DM). Age predicted all late adverse outcomes except restenosis, and DM predicted all of them. A predictor of myocardial infarction, besides age (HR 1.08, 95% CI 1.05-1.11) and DM (HR 1.60, 95% CI 1.11-2.29), was peripheral arterial disease (HR 1.81, 95% CI 1.17-2.78) in personal history. Predictors were only age (HR 1.04, 95% CI 1.01-1.08) and DM (HR 1.68, 95% CI 1.03-2.72) for stroke, as well as for death (HR 1.17, 95% CI 1.12-1.21 and HR 1.94, 95% CI 1.17-3.21, respectively). For restenosis, in addition to DM (HR 1.78, 95% CI 2.62), predictors were hyperlipidemia (HR 3.52, 95% CI 1.27-9.76) and urgent surgery (HR 3.51, 95% CI 1.06-11.65). Conclusions: CEA should be performed with special caution in the elderly and diabetic patients. Modification of other risk factors and precise medical therapy are necessary to reduce possible adverse outcomes.