Introduction:
Published analysis of the NASCET and ECST studies revealed a significant impact of the timing of surgery from symptomatic event, type of symptomatic event, gender, and age on patient outcomes.
Hypothesis:
Identified periprocedural risks of age, gender, timing of procedure, and type of symptomatic event will predict carotid endarterectomy complications in a large community hospital vascular registry and be similar for patients undergoing carotid stenting.
Methods:
Patients were prospectively enrolled in a community hospital carotid vascular registry. The study included patients diagnosed with stroke or transient ischemic attack (TIA) who subsequently underwent carotid endarterectomy or stenting. Procedural risk was defined by occurrence of stroke, myocardial infarction (MI) post-operatively or death within 30 days of the procedure. Multiple logistic regression was conducted to predict procedural risk using age (<65, 65-74, ≥75), gender, time to intervention (<2 weeks, 2-4 weeks, >4 weeks), type of symptom event (TIA, stroke, ocular only) and procedure (stent versus endarterectomy) as predictors.
Results:
Seven hundred and one patients with symptomatic carotid disease were included in the analysis. Over 60% were male and the mean age was 71.2 years. Time of symptom onset to intervention was as follows: 29.7% at <2 weeks, 32.9% at 2-4 weeks and 31.2% at >4 weeks. Twenty-eight patients (4.0%) had post-operative stroke or death within 30 days. No patients experienced an MI. Multiple logistic regression results indicate that the symptomatic event of stroke (n=194) compared to ocular only symptoms (n=257) (Odds Ratio (OR)=2.82, p=.032) and carotid stenting (n=93) versus carotid endarterectomy (n=608) (OR=2.45, p=.046) were significant predictors of periprocedural risk. Timing, gender, age, and TIA symptom event were not significant predictors.
Conclusions:
Our study of symptomatic carotid disease showed that patients with a stroke and those undergoing carotid stenting were at higher risk of periprocedural complications. Timing of surgery, age, gender and TIA symptom events did not have an effect. Future analyses will focus on the risk or benefit of these procedures on long-term functional outcomes.
Relevance of Infarct Size, Timing of Surgery, and Peri-operative Management for Non-ischaemic Cerebral Complications After Carotid Endarterectomy
