Authors: Bennett KM et al., J Vasc Surg 2015 Jan 61:103
The 30-day rate of stroke or death was 3% in a large U.S. cohort.
Perioperative complications — especially stroke or death — are key considerations when patients consider carotid endarterectomy. In this study, researchers used a national surgical database to determine rates and predictors of postoperative stroke and death among 3845 patients who underwent carotid endarterectomy at 78 U.S. medical centers in 2012. Carotid stenosis was symptomatic in 42% of patients and asymptomatic in 58%.
The 30-day incidence of postoperative stroke or death was 3% overall — 4.6% in patients with symptomatic stenosis and 1.9% in those with asymptomatic stenosis. In multivariate analysis, independent predictors of stroke or death among symptomatic patients were emergency surgery, contralateral carotid stenosis of 80% to 99%, previous stroke (as opposed to transient ischemic attack), and one or more “physiologic high-risk characteristics” (as defined by the American College of Surgeons; these included cardiac, pulmonary, and renal comorbidities). Among asymptomatic patients, independent predictors were contralateral stenosis of 80% to 99% and American Society of Anesthesiologists class 4 or 5. The 30-day incidence of nonstroke major complications was 5.3%.
Comment
Ideally, patients undergoing carotid endarterectomy would have access to surgeon-specific and institution-specific rates of postoperative stroke and death. Because this information often is unavailable, studies like this one are necessary to inform clinical decision-making. Interestingly, most endarterectomies in this database were done forasymptomatic carotid stenosis; with contemporary medical management, whether surgery confers any long-term benefit in these patients is unclear. I recently published an analysis of this topic in JAMA Internal Medicine (JAMA Intern Med 2014; 174:2004).