Early and long-term results of carotid endarterectomy in diabetic patients

Dorigo, Walter; Pulli, Raffaele; Pratesi, Giovanni; Fargion, Aaron; Marek, John; Innocenti, Alessandro; Pratesi, Carlo

doi:10.1016/j.jvs.2010.08.030

Cited by 36 publications

(38 citation statements)

References 23 publications

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“…Several studies have shown that patients with diabetes present higher incidence of death and cardiovascular complications when undergoing endarterectomy [13,15]. Diabetes has been described by multiple authors [3,13,16,17,18] as a factor significantly affecting the results of CEA, but others have reported conflicting results [19,20,21,22]. …”

Section: Discussionmentioning

confidence: 99%

“…Dorigo et al [3] showed that diabetes mellitus increased the risk of perioperative death after CEA three-fold. Others found significantly more adverse post-operative cardiac events [22].…”

Section: Discussionmentioning

confidence: 99%

“…Diabetes increases stroke-related mortality, doubles recurrent stroke risk, and triples the frequency of stroke-related dementia [2]. It also raises the perioperative mortality in patients with carotid stenosis treated with endarterectomy (CEA) [3]. It is however unknown whether diabetes increases the complications rate after carotid angioplasty and stenting (CAS).…”

Section: Introductionmentioning

confidence: 99%

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Diabetes Does not Affect Outcome of Symptomatic Carotid Stenosis Treated with Endovascular Techniques

Lago

Parkhutik²,

Tembl³

et al. 2013

Eur Neurol

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Background: The influence of diabetes on carotid revascularization techniques is controversial, with few data regarding angioplasty and stenting (CAS). Our purpose was to analyze whether its presence constitutes a risk factor for poor outcome of patients with carotid stenosis treated with CAS. Methods: We compared 30-day and long term morbidity and mortality, as well as restenosis rates, of non diabetic and diabetic patients with symptomatic carotid stenosis treated with endovascular techniques. Results: 318 consecutive patients, 116 (36.5%) of them diabetics, were followed for a median of 56 months. Cumulative 30-day stroke, ischemic cardiopathy and death rate was 4% for non diabetics and 5.2% for diabetics (non significant). Long term stroke and mortality rate was 26.4% for the first group and 34.3% for the second (non significant). The most frequent causes of death were myocardial infarction (17.5% non diabetics, 44% diabetics, p = 0.04), ischemic stroke (12.5% non diabetics, 4% diabetics, non significant) and cancer (30% non diabetics, 16% diabetics, non significant). Twelve patients (6.4%) had restenosis ≥50%, 5.9% non diabetic, 7.4% diabetic, also without statistical significance. Conclusions: In our series, endovascular treatment is both efficient and safe in diabetic patients with symptomatic carotid stenosis; therefore, the presence of diabetes mellitus did not increase the risks linked to CAS procedure.

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Section: Discussionmentioning

confidence: 99%

“…Dorigo et al [3] showed that diabetes mellitus increased the risk of perioperative death after CEA three-fold. Others found significantly more adverse post-operative cardiac events [22].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Diabetes Does not Affect Outcome of Symptomatic Carotid Stenosis Treated with Endovascular Techniques

Lago

Parkhutik²,

Tembl³

et al. 2013

Eur Neurol

View full text Add to dashboard Cite

show abstract

“…The presence of diabetes might both increase neointimal hyperplasia and accelerate the growth of new carotid plaques at the site of arterial injury, thereby supporting the increased restenosis risk whichever treatment was applied to carotid stenosis. 5,28 …”

Section: Discussionmentioning

confidence: 99%

“…3 There is conflicting evidence on the effect of DM on the outcomes of patients undergoing carotid endarterectomy (CEA). A number of studies reported increased perioperative risk of stroke and death in patients with diabetes undergoing surgery, 4,5 and in some series, it was a marker of coronary insufficiency and a predictor of cardiac adverse events. 6 On the other hand, other studies have documented similar perioperative outcomes during CEA in both patients with and without diabetes.…”

Section: Introductionmentioning

confidence: 99%

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

Casana

Malloggi

Odero

et al. 2018

Diabetes and Vascular Disease Research

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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.

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Does metabolic syndrome influence short and long term durability of carotid endarterectomy and stenting?

Casana

Malloggi

Tolva³

et al. 2018

Diabetes Metabolism Res

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Aims The metabolic syndrome (MetS) is composed of a cluster of related cardiovascular risk factors. The aim of the present study was to determine how MetS contributes to short‐ (30‐day) and long‐term complications and restenosis after carotid endarterectomy (CEA) or stenting (CAS). Methods A consecutive cohort of 752 patients undergoing CEA (n = 314) and CAS (n = 438) in a single institution was examined, of which 296 (39.4%) were identified as having MetS. All patients were followed‐up with carotid duplex ultrasound scan of the supraaortic vessels and a neurological assessment of symptoms status at 30‐day postprocedure and at 3, 6, and 12 months, with annual follow‐up thereafter for 3 years. Results Patients with MetS had a significant increased risk in their 30‐day death, major adverse events (MAE), and restenosis rates, both after CEA and after CAS (death: 0.7% vs 0.0%; MAE: 5.3% vs 2.7%; and restenosis: 1.7% vs 0.2%; p < 0.05). The MAE and restenosis rates remained statistically different at 36 months, with both procedures (29.2% vs 24.2% and 9.5% vs 3.3%, p < 0.05, for patients with and without MetS, respectively). Among the components of MetS, high fasting serum glucose, low high‐density lipoprotein cholesterol, and elevated body mass index were associated with increased risk of complications at 30 days and within 36 months. Conclusions The current study suggested that the presence of MetS is an important risk factor for morbidity and restenosis after CEA and CAS.

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Early and long-term results of carotid endarterectomy in diabetic patients

Cited by 36 publications

References 23 publications

Diabetes Does not Affect Outcome of Symptomatic Carotid Stenosis Treated with Endovascular Techniques

Diabetes Does not Affect Outcome of Symptomatic Carotid Stenosis Treated with Endovascular Techniques

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

Does metabolic syndrome influence short and long term durability of carotid endarterectomy and stenting?

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