POSToperative CerebrovascUlar Accident Following Symptomatic Carotid EndarterectoMy (OSTIUM): A Retrospective Case-Control Study.

Abstract

BackgroundAlthough carotid endarterectomy (CEA) is effective for moderate to severe symptomatic carotid artery stenosis, it carries a risk of postoperative cerebrovascular accident (POCVA). Currently, there is insufficient evidence on the relationship between cranial vascular integrity and intraoperative hemodynamic fluctuations.MethodsIn this retrospective case-control study, we utilised data collected from patients undergoing CEA for symptomatic carotid artery disease between December 2005 and October 2019 in the South Mersey Arterial Centre, UK. Patients with three-dimensional CT angiogram data and evidence of postoperative stroke were considered as cases and matched with those without such evidence considered as controls. 3D-CTA data were analysed following a structured pro-forma and data regarding haemodynamic changes were obtained from operative notes. Variables that showed statistical significance in univariate analysis were included in multivariate logistic regression analysis.ResultsA total of 21 cases and 55 matched controls were identified. Presence of atherosclerotic disease in the vertebral arteries on either side, intracranial atherosclerosis and a drop in the systolic blood pressure were significantly different between cases and controls. Our multivariate logistic regression models indicated that the likelihood of stroke was higher with vertebral artery (V1-V4) stenosis on either side (OR 6.5, 95% CI 1.7-24.6) and an intraoperative systolic blood pressure drop greater than 44 mmHg (OR 6.6, 95% CI 1.6-27.6).ConclusionsThese findings highlight the importance of evaluating posterior circulation abnormalities in POCVA. Moreover, careful intraoperative blood pressure management is crucial in perioperative care. This may aid in developing personalised risk stratification and enhancing intraoperative monitoring during CEA.