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Prophylactic carotid endarterectomy for asymptomatic bruit. A look at cardiac risk
Insights
Prophylactic carotid endarterectomy (PCE) carries significant cardiac risks. Many patients undergoing PCE have pre-existing cardiac issues, leading to cardiac mortality that impacts quality of life.
Area of Science:
- Vascular Surgery
- Cardiology
- Neurosurgery
Background:
- Prophylactic carotid endarterectomy (PCE) is performed to prevent stroke in asymptomatic patients with carotid artery stenosis.
- The role of preoperative cardiac risk factors in outcomes after PCE requires further investigation.
Purpose of the Study:
- To assess the influence of preoperative cardiac risk factors on outcomes following prophylactic carotid endarterectomy.
- To evaluate the impact of cardiac morbidity and mortality on quality of life after PCE.
Main Methods:
- Retrospective analysis of 57 patients undergoing 70 prophylactic carotid endarterectomies.
- Assessment of preoperative cardiac risk factors and perioperative/late follow-up outcomes.
- Kaplan-Meier analysis for cumulative stroke-free occurrence rate.
Main Results:
- 83% of patients (47/57) had at least one preoperative cardiac risk factor.
- One perioperative stroke occurred (cumulative stroke-free rate <6% over five years).
- Cardiac causes accounted for 9 of 15 late deaths (40-120 months post-procedure).
Conclusions:
- Preoperative cardiac risk factors significantly influence outcomes after prophylactic carotid endarterectomy.
- Cardiac morbidity and mortality substantially affect long-term quality of life post-PCE.
- PCE should be considered primarily for patients with minimal cardiac risk or those amenable to risk factor improvement.
Abstract:
We assessed the influence of preoperative cardiac risk factors in 57 patients undergoing 70 prophylactic carotid endarterectomies (PCE) and found that: (1) 47 (83%) had at least one cardiac risk factor and (2) nine of 15 deaths occurring in the late follow-up period (40 to 120 months) were due to cardiac causes. Perioperatively, one patient sustained a mild stroke. Although the cumulative stroke-free occurrence rate was kept to less than 6% over the five-year period, cardiac morbidity and mortality greatly influenced the quality of life after PCE. Therefore, PCE is suggested only for patients who have minimal preoperative cardiac risk factors or for those patients whose cardiac risk factors can be improved by medical therapy.