Higher risks of thirty-day mortality and thromboembolism in disseminated cancer patients undergoing carotid endarterectomy: A perspective from the ACS-NSQIP database from 2011 to 2022.

Abstract

BackgroundAtherosclerosis in carotid arteries can lead to carotid stenosis, where carotid endarterectomy (CEA) is the first-line intervention. Malignancy has a two-way relationship with atherosclerosis, where they share common molecular pathways in their pathophysiology. However, the postoperative outcomes of CEA in patients with disseminated cancer remain unclear. This study aimed to examine the 30-day outcomes of CEA in patients with disseminated cancer.MethodsPatients with and without disseminated cancer who underwent CEA were identified in the ACS-NSQIP targeted database from 2011 to 2022. Patients with age <18 years were excluded. A 1:5 propensity-score matching was used to address preoperative differences between the cohorts. Thirty postoperative outcomes were examined.ResultsThere were 148 (0.37%) patients with disseminated cancer who went under CEA. Meanwhile, 40,028 patients without disseminated cancer underwent CEA, where 740 of them were matched to those with disseminated cancer. After 1:5 propensity-score matching, disseminated cancer patients had higher risks of 30-day mortality (4.73% vs 1.62%, p = .03), and deep vein thrombosis (3.38% vs 0.68%, p = .01), while stroke, transient ischemic attacks, and other 30-day outcomes were comparable between the groups.ConclusionPatients with disseminated cancer had higher thromboembolism and mortality after CEA. Given the prevalence of cancer-related thrombosis and its associated increased mortality risk, effective prophylaxis and treatment for venous thromboembolism, such as low molecular weight heparin administration, should be essential in patients with disseminated cancer. These findings can also be valuable for preoperative risk stratification and in determining the surgical candidacy of patients with disseminated cancer in CEA. CEA for asymptomatic patients with disseminated cancer may require further justification given their elevated perioperative risk.