Is diabetes a marker of higher risk after carotid revascularization? Experience from a single centre

Abstract

Purpose: This single centre study investigates the influence of diabetes mellitus on outcomes following carotid artery endarterectomy or stenting. Methods: In total, 752 carotid revascularizations (58.2% carotid artery stenting and 41.8% carotid endarterectomy) were performed in 221 (29.4%) patients with diabetes and 532 (70.6%) patients without diabetes. The study outcomes were death, disabling and non-disabling stroke, transient ischaemic attack and restenosis within 36 months after the procedure. Results: Patients with diabetes had higher periprocedural risk of any stroke or death (3.6% diabetes vs 0.6% no diabetes; p < 0.05), transient ischaemic attack (1.8% diabetes vs 0.2% no diabetes; p > 0.05) and restenosis (2.7% diabetes vs 0.6% no diabetes; p < 0.05). During long-term follow-up, there were no significant differences in Kaplan-Meier estimates of freedom from death, any stroke and transient ischaemic attack, between people with and without diabetes for each carotid artery stenting and carotid endarterectomy subgroup. Patients with diabetes showed higher rates of restenosis during follow-up than patients without diabetes (36-months estimate risk of restenosis: 21.2% diabetes vs 12.5% no diabetes; p < 0.05). Conclusion:The presence of diabetes was associated with increased periprocedural risk, but no further additional risk emerged during longer term follow-up. Restenosis rates were higher among patients with diabetes.

Impact of Diabetes Mellitus on Early Clinical Outcome and Stent Restenosis after Carotid Artery Stenting

“…However, this hypothesis comes from studies published more than 10 years ago, and it must be acknowledged that in the meantime, progress has been made in terms of endovascular treatment tools and new antiplatelet agents. Only Casana's study was published in 2018, showing the same trend, increased early periprocedural risk, but no further additional risk during longer term follow-up in the diabetic population undergoing CAS [ 23 ]. Restenosis rates reported by Casana et al were also significantly higher among patients with diabetes (21.2% diabetes vs. 12.5% no diabetes at 36-months follow-up).…”

Impact of Diabetes Mellitus on Early Clinical Outcome and Stent Restenosis after Carotid Artery Stenting

“…However, this hypothesis comes from studies published more than 10 years ago, and it must be acknowledged that in the meantime, progress has been made in terms of endovascular treatment tools and new antiplatelet agents. Only Casana's study was published in 2018, showing the same trend, increased early periprocedural risk, but no further additional risk during longer term follow-up in the diabetic population undergoing CAS [23]. Restenosis rates reported by Casana et al were also significantly higher among patients with diabetes (21.2% diabetes vs. 12.5% no diabetes at 36-months followup).…”

Body mass index and early outcomes after carotid endarterectomy

“…Therefore, it is necessary to identify patients with an increased risk of postoperative complications, which would enable adequate selection of those who will undergo surgery [3]. The available literature describes that risk factors for postoperative complications after CEA are most often related to age, sex, body mass index (BMI), the presence of other diseases, especially diabetes, the degree of stenosis and plaque characteristics, type of surgery, and anesthesia [3][4][5][6][7].…”