Clinical and operative predictors of outcomes of carotid endarterectomy

Halm, Ethan A.; Hannan, Edward L.; Rojas, Mary; Tuhrim, Stanley; Riles, Thomas S.; Rockman, Caron; Chassin, Mark R.

doi:10.1016/j.jvs.2005.05.029

Cited by 89 publications

(66 citation statements)

References 44 publications

(71 reference statements)

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“…30,31 In contrast, we found no significant risk associated with the presence of a contralateral occlusion or with a history of cardiac disease. 29,30,32,33 Unstable neurological symptoms as a qualifying event (crescendo TIA) have previously been associated with an increased perioperative risk, but this was not evident from our data. 29 The strength of our study is that we analyze a large population from a national registry.…”

Section: Discussioncontrasting

confidence: 75%

Very Urgent Carotid Endarterectomy Confers Increased Procedural Risk

Strömberg

Gélin

Österberg

et al. 2012

Stroke

165

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Background and Purpose— Current Swedish guidelines recommend that carotid endarterectomy should be performed within 14 days of a qualifying neurological event, but it is not clear if very urgent surgery after an event is associated with increased perioperative risk. The aim of this study was to determine how the time between the event and carotid endarterectomy affects the procedural risk of mortality and stroke. Methods— We prospectively analyzed data on all patients who underwent carotid endarterectomies for symptomatic carotid stenosis between May 12, 2008, and May 31, 2011, with records in the Swedish Vascular Registry (Swedvasc). Patients were divided according to time between the qualifying event and surgery (0–2 days, 3–7 days, 8–14 days, 15–180 days). Stroke rate and mortality at 30 days postsurgery were determined. Results— We analyzed data for 2596 patients and found that the combined mortality and stroke rate for patients treated 0 to 2 days after qualifying event was 11.5% (17 of 148) versus 3.6% (29 of 804), 4.0% (27 of 677), and 5.4% (52 of 967) for the groups treated at 3 to 7 days, 8 to 14 days, and 15 to 180 days, respectively. In a multivariate analysis, time was an independent risk factor for perioperative complications: patients treated at 0 to 2 days had a relative OR of 4.24 (CI, 2.07–8.70; P <0.001) compared with the reference 3- to 7-day group. Conclusions— In this study of patients treated for symptomatic carotid disease, it was safe to perform surgery as early as Day 3 after a qualifying neurological event in contrast to patients treated within 0 to 2 days, which has a significantly increased perioperative risk.

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Section: Discussioncontrasting

confidence: 75%

Very Urgent Carotid Endarterectomy Confers Increased Procedural Risk

Strömberg

Gélin

Österberg

et al. 2012

Stroke

165

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“…Specific scores for CEA (Halm and Tu) 5,6 have been developed with the objective to identify patients at high risk of death and stroke. Although there are other scores such as CEA-8, 19 the first 2 have been used in this study because of their simplicity (5 points each), and because 2 of the 8 factors in CEA-8 are not relevant for our cohort (no patients with a >3 score in the modified Rankin Scale have undergone surgery and there is ethnic homogeneity in our population).…”

Section: Discussionmentioning

confidence: 99%

Clinical Predictors of Major Adverse Cardiovascular Events during Long-Term Follow-Up after Carotid Endarterectomy

Rico

Pita-Fernández

Segura-Iglesias

2015

Annals of Vascular Surgery

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“…In addition, clinical presentation was included as a potential predictor, because it plays an important role in outcome after carotid revascularization. 16 Patients were divided into 3 groups based on their preoperative status or index event: asymptomatic, transient ischemic attack and stroke as reported by the neurologist in charge. Transient ischemic attack was defined as focal neurological symptoms lasting Ͻ24 hours.…”

Section: Predictorsmentioning

confidence: 99%

Clinical Prediction Rule to Estimate the Absolute 3-Year Risk of Major Cardiovascular Events After Carotid Endarterectomy

Lammeren

Catanzariti

Peelen

et al. 2012

Stroke

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Background and Purpose-Prognosis after carotid endarterectomy is mainly determined by the occurrence of major adverse cardiovascular events (MACEs). Optimal medical treatment to reduce risk is the mainstay of MACE prevention. The level of risk of MACE may determine the initiation and aggressiveness of medical treatment, yet a prediction rule to assess that absolute MACE risk after carotid endarterectomy is currently unavailable. Methods-The prediction model was developed in a consecutive cohort of 1138 patients who underwent carotid endarterectomy between 2002 and 2009. Primary end point was MACE and encompassed myocardial infarction, stroke, and cardiovascular death. Fourteen potential clinical predictors were entered into a Cox proportional hazard model. After backward stepwise regression, internal validation was conducted with bootstrapping techniques to correct for overfitting. To provide an easily applicable clinical tool, a score chart was constructed, dividing patients into 4 risk groups. Model performance was assessed in terms of discrimination, calibration, and risk stratification. Results-During a mean follow-up of 2.28 (Ϯ0.95) years, 148 events occurred, corresponding to a cumulative incidence of 13%. Clinical predictors in the final model were age, history of coronary or peripheral artery disease, smoking, systolic blood pressure, use of antihypertensive drugs, clinical presentation, presence of contralateral carotid stenosis, and serum creatinine levels. Discrimination of the final model, in terms of a C statistic, was 0.69 (0.64 -0.73) and calibration showed a good overall fit (Gronnesby and Borgan, Pϭ0.39). The observed incidence of MACE in the 4 risk groups was 6%, 9%, 19%, and 35%, respectively, indicating good overall risk stratification. Conclusions-The clinical prediction model for MACE in the first 3 years after carotid endarterectomy may be used to identify high-risk patients to help optimize medical treatment and risk factor management as part of secondary prevention to increase life expectancy free from MACE. Despite our success in stratifying risk among these patients, even the lowest stratum remains at high risk and all of these patients should receive maximal secondary preventive measures. (Stroke. 2012;43:1273-1278.)

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Clinical and operative predictors of outcomes of carotid endarterectomy

Abstract: Information about these risk factors may help physicians weigh the risks and benefits of carotid endarterectomy in individual patients. Two operative techniques (use of local anesthesia and patch closure) may lower the risk of death or stroke.

Cited by 89 publications

References 44 publications

Very Urgent Carotid Endarterectomy Confers Increased Procedural Risk

Very Urgent Carotid Endarterectomy Confers Increased Procedural Risk

Clinical Predictors of Major Adverse Cardiovascular Events during Long-Term Follow-Up after Carotid Endarterectomy

Clinical Prediction Rule to Estimate the Absolute 3-Year Risk of Major Cardiovascular Events After Carotid Endarterectomy

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