Ann Surg Treat Res.  2019 Oct;97(4):202-209. 10.4174/astr.2019.97.4.202.

Effect of severe contralateral carotid stenosis or occlusion on early and late outcomes after carotid endarterectomy

• Jeong MJ
• Kwon H
• Kim MJ
• Han Y
• Kwon TW
• Cho YP

• KMID: 2459318
• DOI: http://doi.org/10.4174/astr.2019.97.4.202

Abstract

PURPOSE
We aimed to compare clinical outcomes after carotid endarterectomy (CEA) between Korean patients with and without severe contralateral extracranial carotid stenosis or occlusion (SCSO).
METHODS
Between January 2004 and December 2014, a total of 661 patients who underwent 731 CEAs were stratified by SCSO (non-SCSO and SCSO groups) and analyzed retrospectively. The study outcomes included the occurrence of major adverse cardiovascular events (MACE), defined as stroke or myocardial infarction, and all-cause mortality during the perioperative period and within 4 years after CEA.
RESULTS
There were no significant differences in the incidence of MACE or any individual MACE manifestations between the 2 groups during the perioperative period or within 4 years after CEA. On multivariate analysis to identify clinical variables associated with long-term study outcomes, older age (hazard ratios [HRs], 1.06; 95% confidence intervals [CIs], 1.03-1.09; P < 0.001) and diabetes mellitus (HR, 1.71; 95% CI, 1.14-2.57; P = 0.010) were significantly associated with an increased risk of MACE occurrence, while preexisting SCSO was not associated with long-term incidence of MACE and individual MACE components. Kaplan-Meier survival analysis showed similar MACE-free (P = 0.509), overall (P = 0.642), and stroke-free (P = 0.650) survival rates in the 2 groups.
CONCLUSION
There were no significant differences in MACE incidence after CEA between the non-SCSO and SCSO groups, and preexisting SCSO was not associated with an increased risk of perioperative or long-term MACE occurrence.

Keyword

Carotid endarterectomy; Carotid stenosis; Outcomes; Stroke

MeSH Terms

Carotid Stenosis*
Diabetes Mellitus
Endarterectomy, Carotid*
Humans
Incidence
Mortality
Multivariate Analysis
Myocardial Infarction
Perioperative Period
Retrospective Studies
Stroke
Survival Rate

Figure

• 

  Fig. 1 Kaplan-Meier analyses of the cumulative event-free rates. Major adverse cardiovascular event (MACE)-free (A), overall (B), and stroke-free survival (C) rates in patients, with and without severe contralateral extracranial carotid stenosis or occlusion (SCSO), who underwent carotid endarterectomy.

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