Minor complications, common after carotid endarterectomy, are associated with higher postoperative risk of death and stroke

Introduction Histological assessment studies have identified the presence of intraplaque hemorrhage (IPH) as an indicator of plaque instability and resulting ischemic cerebral sequelae. Although the presence of IPH has been studied extensively in relation to neurological symptoms preceding carotid endarterectomy (CEA) or as a predictor for postoperative risk of major adverse cardiovascular events (MACE), the degree of IPH has not been studied before. Glycophorin, an erythrocyte-specific protein, has been suggested as a marker for the degree of previous hemorrhages in atherosclerotic plaque since erythrocytes are prominently present in IPH. We hypothesized that quantified plaque glycophorin C, as a proxy for the degree of IPH, is associated with destabilizing plaque characteristics, preprocedural symptoms, and increased postoperative risk for MACE. Methods We quantified glycophorin C and six other plaque characteristics with the slideToolkit method. We used human atherosclerotic plaque samples from 1971 consecutive asymptomatic and symptomatic (carotid endarterectomy) patients in the Athero-Express Biobank. Results The total area of glycophorin C in plaque was larger in individuals with a plaque with IPH compared to individuals with plaque without IPH (p<0.001). Quantified glycophorin C was significantly associated with ipsilateral pre-procedural neurological symptoms (OR:1.27, 95%CI:1.06-1.41, p=0.005). In addition, quantified glycophorin C was independently associated with an increased postoperative risk for MACE (HR:1.31, 95%CI:1.01-1.68, p=0.04). Stratified by sex, quantified glycophorin C was associated with an increased postoperative risk for MACE in male patients (HR:1.50, 95%CI:1.13-1.97, p=0.004), but not in female patients (HR:0.70, 95%CI:0.39-1.27, p=0.23). Conclusion Quantified glycophorin C, as a proxy for the degree of IPH, was independently associated with the presence of IPH, symptomatic preprocedural symptoms, and with an increased three-year postoperative risk of MACE. These findings indicate that quantified plaque glycophorin C can be considered as a marker for identifying male patients with a high residual risk for secondary MACE after CEA.

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Cementing does not increase the immediate postoperative risk of death after total hip arthroplasty or hemiarthroplasty: a hospital-based study of 10,677 patients

Acta Orthopaedica ◽

10.1080/17453674.2019.1596576 ◽

2019 ◽

Vol 90 (3) ◽

pp. 270-274 ◽

Cited By ~ 7

Author(s):

Elina Ekman ◽

Inari Laaksonen ◽

Kari Isotalo ◽

Antti Liukas ◽

Tero Vahlberg ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Total Hip ◽

Risk Of Death ◽

Postoperative Risk

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Renal insufficiency and altered postoperative risk in carotid endarterectomy

Journal of Vascular Surgery ◽

10.1016/s0741-5214(99)70241-7 ◽

1999 ◽

Vol 29 (6) ◽

pp. 1006-1011 ◽

Cited By ~ 36

Author(s):

Allen D. Hamdan ◽

Frank B. Pomposelli ◽

Gary W. Gibbons ◽

David R. Campbell ◽

Frank W. LoGerfo

Keyword(s):

Renal Insufficiency ◽

Carotid Endarterectomy ◽

Postoperative Risk

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Impact of diabetes mellitus on early outcome of carotid endarterectomy

VASA ◽

10.1024/0301-1526/a000737 ◽

2019 ◽

Vol 48 (2) ◽

pp. 148-156

Author(s):

Andreja Dimic ◽

Miroslav Markovic ◽

Dragan Vasic ◽

Marko Dragas ◽

Petar Zlatanovic ◽

...

Keyword(s):

Diabetes Mellitus ◽

Carotid Artery ◽

Carotid Endarterectomy ◽

Blood Glucose Control ◽

Density Lipoprotein ◽

Diabetic Group ◽

Treatment Modalities ◽

Diabetic Patients ◽

Early Outcome ◽

Risk Of Death

Abstract. Background: Diabetes mellitus increases the risk of ischaemic stroke in the general population but its impact on early outcome after the carotid endarterectomy (CEA) is controversial with conflicting results. Patients and methods: This prospective study includes 902 consecutive CEAs. Patients were divided into non-diabetic and diabetic groups and subsequently analysed. Early outcomes in terms of 30-day stroke and death rates were then analysed and compared. Results: There were 606 non-diabetic patients. Among 296 diabetic patients, 83 were insulin-dependent. The cumulative TIA/stroke rate was statistically higher in the diabetic group (2.6 vs. 5.7 %, P = 0.02). Stroke was more frequent in the diabetic group (2.0 vs. 4.4 %, P = 0.04) comparedto TIA (0.7 vs. 1.4 %, P = 0.45). Mortality was statistically more frequent in diabetic patients (0.2 vs. 1.7 %, P = 0.01). The 30-day stroke/death rate (2.6 vs. 5.7 %, P = 0.02) was also statistically higher in the diabetic group. Factors that were identified to increase risk of death and stroke in multivariate analysis were: use of insulin for blood glucose control (OR = 2.47, 95 % CI 1.61–4.68, P = 0.01), higher low-density lipoprotein cholesterol value (OR = 1.52, 95 % CI 1.15–2.22, P < 0.01), presence of coronary disease (OR = 2.04, 95 % CI 1.40–3.31, P = 0.03), peripheral artery disease (OR = 2.14, 95 % CI 1.34–3.65, P = 0.02), complicated plaque (OR = 1.77, 95 % CI 1.11–3.68, P = 0.03), contralateral carotid artery occlusion (OR = 2.37, 95 % CI 1.25–4.74, P = 0.02), shunt use (OR = 3.46, 95 % CI 1.18–7.10, P < 0.01), and among diabetic patients higher HbA1c levels (OR = 1.28, 95 % CI 1.05–1.66, P = 0.03). Clamp toleration was associated with lower risk of death and stroke rates (OR = 0.43, 95 % CI 0.23–0.76, P < 0.01). Conclusions: In our study, perioperative neurological complications and mortality were statistically higher in diabetic patients compared to non-diabetic patients during CEA. Further research will have to show whether other treatment modalities of carotid artery stenosis and better glycaemia and dyslipidaemia controlling in diabetics can reduce this risk.

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