Intraoperative Completion Studies and Their Associations With Carotid Endarterectomy Outcomes.

Objective: This study aimed at assessing outcomes after carotid endarterectomy (CEA) in dependence of center policy with respect to imaging intraoperative completion study (ICS i ) usage.

Background: Although randomized controlled studies are missing, a beneficial effect was shown for ICS i techniques (ie, angiography and intraoperative duplex ultrasound) after CEA.

Methods: This secondary data analysis is based on the German statutory quality assurance database. The research was funded by Germany's Federal Joint Committee Innovation Fund (G-BA Innovationsfonds, 01VSF19016 ISAR-IQ). According to their ICS i policy, hospitals were categorized as routine ICS i (>90%), selective ICS i (10%-90%), or sporadic ICS i (<10%) centers. Primary study outcome was in-hospital stroke or death. Multivariable regression analyses were performed.

Results: Between 2012 and 2016, a total of 119,800 patients underwent CEA. In-hospital stroke or death rates were lower in routine ICS i centers (1.7%) compared with selective (2.1%) and sporadic ICS i centers (2.0%). The multivariable regression analysis showed, that in routine ICS i centers, ICS i use was associated with lower rates of stroke or death (adjusted odds ratio: 0.64; 95% CI: 0.44-0.93). In selective ICS i centers, ICS i was not associated with the occurrence of either of the assessed outcomes. In sporadic ICS i centers, ICS i was associated with higher rates of stroke or death (adjusted odds ratio: 1.91; 95% CI: 1.26-2.91).

Conclusions: Lowest in-hospital stroke or death rates are achieved in routine ICS i centers. Although ICS i is associated with a lower perioperative risk in routine ICS i centers, it might act as a surrogate marker for worse outcomes due to intraoperative irregularities in sporadic ICS i centers. Routine use of ICS i is advisable.