Early results of carotid endarterectomy and risk factors for in-hospital stroke

Abstract

Aim: Carotid endarterectomy (CEA), which is performed to prevent the development of cerebrovascular events (CVE) due to carotid artery disease (CAD), is currently the most effective treatment. Perioperative adverse clinical conditions may develop due to patient factors, technique or other reasons. Perioperative stroke is the cause of mortality and morbidity that can develop within 30 days postoperatively. The aim of this study is to present the early results of patients who underwent CEA and investigate the factors affecting the development of early stroke. Material and Methods: Patients who underwent CEA between 2013-2020 were retrospectively analyzed. 529 patients were evaluated. A total of 550 endarterectomy procedures were performed in 529 patients. Demographic data, presence of symptoms, contralateral carotid artery stenosis, anesthetic method, operation technique, postoperative stroke, mortality were recorded from the hospital database. Results: The analyses were based on the results of 550 endarterectomy. The mean age of the patients was 67.0±8.4 years. While 164 (29.8%) of the patients were symptomatic, concomitant contralateral carotid artery stenosis was detected in 138 (25.1%) patients. Considering early postoperative adverse effects, there was no cranial nerve damage, while reoperation for bleeding was necessary in 27 (4.9%) patients. Postoperative ischemic stroke occurred in 20 (3.6%) patients. Mortality occurred in eight (1.5%) patients. Gender, rate of DM, HL, CRF or current CAD did not differ in patients with and without postoperative stroke. The patients with postoperative stroke tended to more frequently have contralateral ICA stenosis but the groups did not differ significantly (p=0.117). In early stroke development after CEA, the presence of pre-procedural symptoms was a significant factor (p<0.001). According to the multivariate analysis preoperative presence of symptoms increased risk by 6.41 (95% CI: 2.22-18.54, p=0.001). Conclusion: Carotid artery revascularization is a safe and effective treatment modality for the prevention of ischemic CVE with low mortality and morbidity rate. Being symptomatic is a significant risk factor for the development of stroke in the early period. It may be useful to group the symptoms and evaluate the extent to which each symptom affects the development of stroke in prospective randomized studies.