A single-center retrospective study with 1-year follow-up after CEA in patients with severe carotid stenosis with contralateral carotid artery occlusion

Abstract

ObjectiveTo analyze the risk factors associated with adverse events after carotid endarterectomy (CEA) in patients with unilateral severe carotid stenosis and contralateral occlusion.MethodsPatients were recruited for CEA between August 2014 and February 2020. CEA was performed under general anesthesia. The carotid clamp time (CCT; long CCT: >20 min) is defined as the period between clamp-on and clamp-off for the stenotic carotid artery. The perioperative factors and postoperative adverse events were recorded. All patients were followed up for 1 year after CEA.ResultsSixty subjects (65.8 ± 7.2 years; 54 males) were included. Patients with adverse events had significantly longer CCT than those without adverse events (60% vs. 40%, P = 0.013). Univariate logistic regression analysis showed that a history of diabetes was significantly associated with adverse events (OR, 0.190; 95% CI, 0.045–0.814; P = 0.025); long CCT was significantly associated with adverse events (OR, 8.500; 95% CI, 1.617–44.682; P = 0.011). After adjusting for confounding factors, including age, sex, BMI, diabetes, PSV, long CCT, non–use of shunt, and history of stroke or TIA, the associations between diabetes and adverse events (OR, 0.113; 95% CI, 0.013–0.959; P = 0.046) were statistically significant; the associations between long CCT and adverse events (OR, 1.301; 95% CI, 1.049–1.613; P = 0.017) were statistically significant.ConclusionsA longer carotid clamp time (>20 min) and a history of diabetes may increase the risk of adverse events in patients with unilateral severe carotid stenosis and contralateral occlusion after CEA. With good preoperative evaluation and intraoperative monitoring, the use of shunts may not be needed intraoperatively in patients with unilateral severe carotid stenosis and contralateral occlusion.

Outcomes of carotid endarterectomy

“…Several studies have emphasized that reducing carotid clamping times may decrease the risk of adverse events in patients undergoing this intervention. 20 , 21 In our center, the mean carotid clamping time was 5.3±3.7 minutes; however, no significant link between prolonged clamping time and the development of postoperative complications was found. This may be attributed to the accurate preoperative diagnostic methods and prudent application of the shunting approach.…”

Investigating the Association of Carotid Atherosclerotic Plaque MRI Features and Silent Stroke After Carotid Endarterectomy

“…Two precautions were taken to prevent the disruption of carotid plaque for CEA patients, especially for those with vulnerable plaque: 1) preoperative intensive statin therapy (40 mg/d); and 2) optimization of intraoperative operations: separating carotid artery gently to reduce touching and squeezing and clamping the external carotid artery, internal carotid artery and common carotid artery sequentially after separation of carotid artery. The details of the surgical procedures have been described in previous studies 22,23 …”