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Late stroke in patients after carotid endarterectomy
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Patients with ulcerated carotid artery plaque face a higher risk of late stroke after endarterectomy. Plaque ulceration indicates a predisposition to stroke, even in the contralateral artery.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiovascular Medicine
Background:
- Carotid artery atherosclerotic plaque ulceration can predispose patients to emboli and late stroke.
- Patients with ulcerated plaque may have a higher risk of stroke post-carotid endarterectomy compared to those without.
Purpose of the Study:
- To investigate the association between carotid artery plaque ulceration and the risk of late stroke after carotid endarterectomy.
- To determine if plaque ulceration predicts future stroke events.
Main Methods:
- Examined 750 carotid endarterectomy specimens for plaque ulceration.
- Assessed degree of stenosis via duplex scan/angiography and intraoperatively.
- Followed 638 patients for a median of 3.6 years to calculate late stroke risk (>30 days post-procedure).
Main Results:
- Late stroke occurred in 48 patients; those with ulcerated plaque had strokes earlier (median 2.0 years) than those without (median 5.2 years).
- Plaque ulceration was associated with a lower 14-year stroke-free survival rate (P < 0.05).
- Patients with initial carotid ulcers had an increased risk of developing ulcers in the contralateral artery (P < 0.005).
Conclusions:
- Carotid artery plaque ulceration is a significant risk factor for late stroke after endarterectomy.
- Some individuals exhibit a predisposition to plaque ulceration and subsequent stroke.
Background:
Some patients may be more predisposed to develop an ulceration of atherosclerotic plaque in the carotid artery, and emboli. These patients should be more at risk for a late stroke even after carotid endarterectomy than patients who are not.
Materials And Methods:
Six-hundred thirty-eight patients had 750 carotid endarterectomies. Excised plaque specimens were examined for gross ulceration. The degree of stenosis was determined by duplex scan and/or angiography, and at operation. The median follow-up time was 3.6 years. The risk of a stroke occurring >30 days after carotid endarterectomy was calculated. Within 1 year, an endarterectomy of the contralateral artery was done in 77 patients (Subgroup) at a median time of 60 days.
Results:
Late stroke occurred in 48 patients. Patients who had had ulcerated plaque had a stroke at a median time of 2.0 years, and patients who had had no ulcers had a stroke at a median time of 5.2 years (P < 0.025). The 14-year stroke-free curve was lower (P < 0.05) if there was plaque ulceration. In the Subgroup, plaque ulcers were found in 55 patients (71%) at the first endarterectomy and later in 46 of the 55 patients (84%) in the contralateral artery. No ulcers were found in 22 patients (29%) initially, but later 50% had ulcers in the contralateral artery. The risk of an ulcer in the contralateral artery was increased (P < 0. 005) in those patients who had ipsilateral carotid ulcers.
Conclusions:
Some patients appear to be predisposed for plaque ulceration and late stroke.