Severe contralateral carotid stenosis or occlusion drive 30-day risk after carotid endarterectomy

Abstract

Objectives The significant effects on the treatment of severe carotid stenosis by carotid endarterectomy have been widely recognized. However, it is controversial whether patients with severe contralateral carotid stenosis or occlusion (SCSO) can benefit from carotid endarterectomy surgery. This study aimed to estimate the SCSO effects on early outcomes after carotid endarterectomy with selective shunting. Methods Between August 2011 and October 2019, a total of 617 patients who underwent carotid endarterectomy with selective shunting were analyzed. SCSO was defined as >70% luminal narrowing of the contralateral extracranial carotid stenosis or occlusion. Of these patients, 116 were categorized into an SCSO group while the rest were assigned to the non-SCSO group. Primary study outcomes were the occurrence of major adverse events, defined as stroke, all-cause mortality, and myocardial infarction during the perioperative period after carotid endarterectomy. Traditional multivariable logistic regression model and logistic regression model adjusted for propensity scores were used to estimate the SCSO effects on primary outcomes. Interaction and stratified analyses were conducted according to age, sex, comorbidities (hypertension, diabetes), preoperative neurological deficit, preoperative symptoms, and shunt use. Results Mean age was 68.5 ± 9.2 years (86.1% men). Overall major adverse events rate within 30 days was 2.5%. Major adverse events rates in SCSO and non-SCSO groups were 9.5% and 1.6%, respectively. This difference was statistically significant ( p < 0.001). In multivariable regression analysis, patients with SCSO had a higher risk of major adverse events (non-SCSO vs. SCSO: aOR 5.05 [95% CI, 1.78–14.55]). In 342 propensity score matched patients, results were consistent (propensity score: aOR, 3.78 [95% CI, 1.13–12.64]). Conclusions SCSO is an independent predictor of 30-day major adverse events. Whether these patients with SCSO are suitable for carotid endarterectomy should be carefully considered.

Diabetes mellitus and adverse outcomes after carotid endarterectomy: A systematic review and meta-analysis

“…A total of 624 records were identified from 5 databases and 19 studies were included for final quantitative synthesis [Figure 1]. [927]…”

“…For 30-day MAEs (11 studies, 53,187 patients), [ 11 – 14 , 16 – 20 , 24 , 27 ] carotid artery stenosis patients with DM had a higher risk of 30-day MAEs than patients without DM (ES: 1.52, 95% CI: 1.15–2.01, P <0.001; prevalence in DM vs. non-DM: 5.1% vs. 3.4%). And the estimate of the risk of short-term MAEs was not substantially changed in the sensitivity analysis (ES: 1.54, 95% CI: 1.25–1.89; P <0.001).…”

“…A total of 624 records were identified from 5 databases and 19 studies were included for final quantitative synthesis [Figure 1]. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Characteristics of the included studies Among the 19 studies in this meta-analysis, 122,003 patients undergoing CEA were included. All CEA procedures were performed after the year 2000, and studies were based on clinical registries, public medical databases, or single-center databases.…”

“…Carmo et al [9] Casana et al [10] Dasenbrock et al [11] Dimic et al [12] Eslami et al [13]* Feng et al [14] Hussain et al [15] Jeong et al [16] Macharzina et al [17] Mizuhashi et al [18] Mulaudzi et al [19] Parlani et al [20] Persson et al [21] Piazza et al [22] Pini et al [23] Pothof et al [24] Pothof et al [25] Stavrinou et al [26] Zhao et al [27] (HR: 0.84, 95% CI: 0.59-1.22) or stroke (HR: 1.15, 95% CI: 0.79-1.09) during long-term follow-up. In Boulanger et al's [30] study, DM was associated with an increased short-term risk of death (RR: 1.85, 95% CI: 1.56-2.18) but not MI (RR: 1.66, 95% CI: 0.94-2.95).…”