A Study of Preoperative Risk Factors and Postoperative Results in Patients Who Have Undergone Unilateral Carotid Endarterectomy
Abstract
Objective: In this
study, the relationship between preoperative risk factors and operative
outcomes in patients undergoing unilateral carotid endarterectomy was compared
in the light of literature reviews.
Material – Method:
223 patients who underwent unilateral carotid endarterectomy in Dr.Siyami Ersek
Breast Heart and Vascular Surgery Training and Research Hospital in the years
between 2007 and 2009 were included in the study. The mean age of the patients
was 68.13 ± 5,25 and 29,5% of them were women (n=66) while 70,5% of them were
men (n=157). 43.5% of patients (n=97) had hypertension and 61.2% of patients (n
= 136) had diabetes mellitus. 76.1% of patients (n = 170) had a history of
smoking while 29.3% of patients (n = 65) had hyperlipidemia. In 5.4% (n = 12)
of patients experienced perioperative stroke, 10.8% (n = 24) of patients had a
history of prolonged neurologic disease and 6.8% (n = 15) of patients had
experienced transient ischemic attacks.
Results: Patients
undergoing carotid endarterectomy in the postoperative period were followed
under 3 main headings: early neurologic complications, early cardiac
arrhythmias and other complications (multiple organ failure, respiratory
problems and hypertension). Early neurologic complications in patients were
followed by the frequency of stroke, transient ischemic attack (TIA), and
prolonged reversible ischemic neurological disease (PRIND). In this group, the
rate of stroke patients in the postoperative period was 2.2% (n = 5) while the
rate of TIA or PRIND patients was 4.1% (n = 9).
Conclusion: Reducing
mortality and morbidity after carotid artery endarterectomy is possible with a
good analysis of preoperative risks and a good preoperative preparation. Cardiovascular
surgeons have a great role and responsibility to reduce the risk and
complications of carotid artery endarterectomy in preoperative, intraoperative
and postoperative periods.
Keywords
Carotid artery diseases; carotid stenosis; neurological symptom; stroke; surgical treatment
References
- 1. Liapis CD, Bell PR, Mikhailidis D, Sivenius J, Nicolaides A, Fernandes e Fernandes J, et al. ESVS guidelines. Invasive treatment for carotid stenosis: indications, techniques. Eur J Vasc Endovasc Surg 2009;37(4 Suppl):1-19.2. Hıdıroğlu M, Çetin L, Kunt A, Karakişi O, Küçüker A, Şener E. Karotis arter hastalıklarında karotis endarterktomi erken sonuçları. Turk Gogus Kalp Dama 2010;18:190-5.
- 3. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 1991;325:445-53. 4. Hobson RW 2nd, Mackey WC, Ascher E, Murad MH, Calligaro KD, Comerota AJ, et al. Management of atherosclerotic carotid artery disease: clinical practice guidelines of the Society for Vascular Surgery. J Vasc Surg 2008;48:480-65. Callow AD. Recurrent stenosis after carotid endarterectomy. Arch Surg 1982;117:1082-1085
- 6. Mattos MA, Hodgson KJ, Londrey GL, et al. Carotid endarterectomy: operative risks, recurrent stenosis, and long term stroke rates in a modern series. JCarovasc Surg 1992;33:387-4007. Civil ID, O’Hara PJ, Hertzer NR, Krajewski LP, Beven EG. Late patency of thecarotid artery after endarterectomy. Problems of definition, follow-up methodology, and data analysis. J Vasc Surg 1988; 8: 79–85.8.NASCET Investigators. North American Symptomatic Carotid Endarterectomy Trial: methods, patient characteristics, and progress. Stroke 1991;22:711-7209. Beard JD. Does serial postoperative clinical or duplex surveillance reduce long- term stroke risk In: Naylor AR, Mackey WC, eds. Carotid Artery Surgery: AProblem- based Approach. London, UK: Harcourt Publishers Ltd, 2000: 360-610. Beard JD. Does serial postoperative clinical or duplex surveillance reduce the long-term stroke risk? In: Naylor AR, Mackey WC, eds. Carotid Artery Surgery: A Problem-based Approach. London, UK: Harcourt Publishers Ltd, 2000: 360–6.11. BARI investigators. Seven-year outcome in the by-pass angioplasty revascularization investigation (BARI) by treatment and diabetic status. J Am CollCardiol 2000; 35:112–119.
- 12. Cho JS, Pandurangi K, Conrad MF et al. Safety and durability of redo carotid operation: an 11-year experience. J Vasc Surg2004; 39: 155–61.
- 13. European Carotid Surgery Trialists' Collaborative Group. MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. Lancet. 1991 May 25;337:1235-43.
- 14. Cremonesi A, Manetti R, Setacci F, Setacci C, Castriota F. Protected carotid stenting: clinical advantages and complications of embolic protection devices in 442 consecutive patients, Stroke , 2003, vol. 34 (pg. 1936-1941)
- 15. Massop, D. , Dave, R. , Metzger, C. , Bachinsky, W. , Solis, M. , Shah, R. , Schultz, G. , Schreiber, T. , Ashchi, M. and Hibbard, R. (2009), Stenting and Angioplasty with Protection in Patients at High‐Risk for Endarterectomy: SAPPHIRE Worldwide Registry First 2,001 Patients. Cathet. Cardiovasc. Intervent., 73: 129-136.
- 16. Mayberg MR, Wilson SE, Yatsu F, Weiss DG, Messina L, Hershey LA, Colling C, Eskridge J, Deykin D, Winn HR; Veterans Affairs Cooperative Studies Program 309 Trialist Group. Carotid endarterectomy and prevention of cerebral ischemia in symptomatic carotid stenosis. JAMA.1991;266:3289–3294
- 17. Mosca L, Benjamin EJ, Berra K, Bezanson JL, Dolor RJ, Lloyd-Jones DM, Newby LK, Pina IL, Roger VL, Shaw LJ, Zhao D, Beckie TM, Bushnell C, D'Armiento J, Kris-Etherton PM, Fang J, Ganiats TG, Gomes AS, Gracia CR, Haan CK, Jackson EA, Judelson DR, Kelepouris E, Lavie CJ, Moore A, Nussmeier NA, Ofili E, Oparil S, Ouyang P, Pinn VW, Sherif K, Smith SCJr., Sopko G, Chandra-Strobos N, Urbina EM, Vaccarino V, Wenger NK. Effectiveness-based guidelines for the prevention of cardiovascular disease in women: 2011 update: a guideline from the American Heart Association, J Am Coll Cardiol , 2011, vol. 57 (pg. 1404-1423)
Abstract
References
- 1. Liapis CD, Bell PR, Mikhailidis D, Sivenius J, Nicolaides A, Fernandes e Fernandes J, et al. ESVS guidelines. Invasive treatment for carotid stenosis: indications, techniques. Eur J Vasc Endovasc Surg 2009;37(4 Suppl):1-19.2. Hıdıroğlu M, Çetin L, Kunt A, Karakişi O, Küçüker A, Şener E. Karotis arter hastalıklarında karotis endarterktomi erken sonuçları. Turk Gogus Kalp Dama 2010;18:190-5.
- 3. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 1991;325:445-53. 4. Hobson RW 2nd, Mackey WC, Ascher E, Murad MH, Calligaro KD, Comerota AJ, et al. Management of atherosclerotic carotid artery disease: clinical practice guidelines of the Society for Vascular Surgery. J Vasc Surg 2008;48:480-65. Callow AD. Recurrent stenosis after carotid endarterectomy. Arch Surg 1982;117:1082-1085
- 6. Mattos MA, Hodgson KJ, Londrey GL, et al. Carotid endarterectomy: operative risks, recurrent stenosis, and long term stroke rates in a modern series. JCarovasc Surg 1992;33:387-4007. Civil ID, O’Hara PJ, Hertzer NR, Krajewski LP, Beven EG. Late patency of thecarotid artery after endarterectomy. Problems of definition, follow-up methodology, and data analysis. J Vasc Surg 1988; 8: 79–85.8.NASCET Investigators. North American Symptomatic Carotid Endarterectomy Trial: methods, patient characteristics, and progress. Stroke 1991;22:711-7209. Beard JD. Does serial postoperative clinical or duplex surveillance reduce long- term stroke risk In: Naylor AR, Mackey WC, eds. Carotid Artery Surgery: AProblem- based Approach. London, UK: Harcourt Publishers Ltd, 2000: 360-610. Beard JD. Does serial postoperative clinical or duplex surveillance reduce the long-term stroke risk? In: Naylor AR, Mackey WC, eds. Carotid Artery Surgery: A Problem-based Approach. London, UK: Harcourt Publishers Ltd, 2000: 360–6.11. BARI investigators. Seven-year outcome in the by-pass angioplasty revascularization investigation (BARI) by treatment and diabetic status. J Am CollCardiol 2000; 35:112–119.
- 12. Cho JS, Pandurangi K, Conrad MF et al. Safety and durability of redo carotid operation: an 11-year experience. J Vasc Surg2004; 39: 155–61.
- 13. European Carotid Surgery Trialists' Collaborative Group. MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. Lancet. 1991 May 25;337:1235-43.
- 14. Cremonesi A, Manetti R, Setacci F, Setacci C, Castriota F. Protected carotid stenting: clinical advantages and complications of embolic protection devices in 442 consecutive patients, Stroke , 2003, vol. 34 (pg. 1936-1941)
- 15. Massop, D. , Dave, R. , Metzger, C. , Bachinsky, W. , Solis, M. , Shah, R. , Schultz, G. , Schreiber, T. , Ashchi, M. and Hibbard, R. (2009), Stenting and Angioplasty with Protection in Patients at High‐Risk for Endarterectomy: SAPPHIRE Worldwide Registry First 2,001 Patients. Cathet. Cardiovasc. Intervent., 73: 129-136.
- 16. Mayberg MR, Wilson SE, Yatsu F, Weiss DG, Messina L, Hershey LA, Colling C, Eskridge J, Deykin D, Winn HR; Veterans Affairs Cooperative Studies Program 309 Trialist Group. Carotid endarterectomy and prevention of cerebral ischemia in symptomatic carotid stenosis. JAMA.1991;266:3289–3294
- 17. Mosca L, Benjamin EJ, Berra K, Bezanson JL, Dolor RJ, Lloyd-Jones DM, Newby LK, Pina IL, Roger VL, Shaw LJ, Zhao D, Beckie TM, Bushnell C, D'Armiento J, Kris-Etherton PM, Fang J, Ganiats TG, Gomes AS, Gracia CR, Haan CK, Jackson EA, Judelson DR, Kelepouris E, Lavie CJ, Moore A, Nussmeier NA, Ofili E, Oparil S, Ouyang P, Pinn VW, Sherif K, Smith SCJr., Sopko G, Chandra-Strobos N, Urbina EM, Vaccarino V, Wenger NK. Effectiveness-based guidelines for the prevention of cardiovascular disease in women: 2011 update: a guideline from the American Heart Association, J Am Coll Cardiol , 2011, vol. 57 (pg. 1404-1423)
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Surgical Science Research Articles |
| Authors | |
| Publication Date | December 29, 2018 |
| Acceptance Date | December 26, 2018 |
| Published in Issue | Year 2018Volume: 40 Issue: 4 |