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Published on: September 19, 2016
The practice of carotid endarterectomy in a large metropolitan area
Insights
Carotid endarterectomy for symptomatic disease carried a higher stroke risk (11.6%) than for asymptomatic disease (5.6%). This review highlights the need for improved perioperative medical therapy to reduce stroke complications.
Area of Science:
- Vascular Surgery
- Neurology
- Public Health
Background:
- Carotid endarterectomy is a surgical procedure to remove plaque from carotid arteries.
- Stroke is a major complication associated with carotid endarterectomy.
Purpose of the Study:
- To evaluate the operative stroke and mortality rates of carotid endarterectomies.
- To compare outcomes between asymptomatic and symptomatic patients undergoing carotid endarterectomy.
Main Methods:
- Retrospective review of 431 carotid endarterectomies performed in the greater Cincinnati metropolitan area in 1980.
- Analysis of operative stroke, mortality, and combined morbidity and mortality rates.
- Comparison of outcomes based on patient symptomatology (asymptomatic vs. symptomatic).
Main Results:
- The overall operative stroke rate was 8.6% and the operative mortality rate was 2.8%.
- Symptomatic patients had a significantly higher stroke rate (11.6%) compared to asymptomatic patients (5.6%).
- A significant portion of strokes occurred after a neurologically intact interval, suggesting potential issues beyond immediate surgical complications.
Conclusions:
- Carotid endarterectomy for symptomatic carotid disease is associated with a higher stroke risk.
- The occurrence of late strokes suggests a need to investigate adjunctive perioperative medical therapies.
- Further research is warranted to optimize perioperative management and reduce stroke incidence after carotid endarterectomy.
Abstract:
All carotid endarterectomies performed in the greater Cincinnati metropolitan area during 1980 were reviewed. For the 431 procedures performed in 16 hospitals, the operative stroke rate was 8.6% (37 of 431), and the operative mortality rate was 2.8% (12 of 431). The combined morbidity and mortality was 9.5% (41 of 431). Fifty percent of the procedures were done for asymptomatic carotid disease (216 of 431) and 50% were done for symptomatic carotid disease (215 of 431). The stroke rate was 5.6% for the asymptomatic patients and 11.6% for the symptomatic patients (difference significant, p less than 0.05). Neurosurgeons and vascular surgeons had similar surgical morbidity. All of the operative strokes involved the hemisphere ipsilateral to the endarterectomy. Fifty-seven percent of the operative strokes (21 of 37) occurred after a neurologically intact interval lasting hours to days. Four occurred following combined endarterectomy-coronary bypass surgery, and one was an intracerebral hemorrhage. The other late strokes (17) occurred without evidence for cardiac embolus or hemorrhage, consistent with a thrombogenic-embologenic operative site, and raising the question of need for adjunctive perioperative medical therapy.
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