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CURRENT ISSUETHE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery


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The Journal of Cardiovascular Surgery 2012 June;53(3):333-43

language: English

High-risk patients for carotid endarterectomy: turned down cases are rare

Marcucci G. 1, Accrocca F. 1, Antonelli R. 1, Giordano A. G. 1, Gabrielli R. 1, Mounayergi F. 3, Sbroscia A. 2, Siani A. 1

1 Unit of Vascular and Endovascular Surgery, San Paolo Hospital, Civitavecchia, Rome, Italy;
2 Unit of Anesthesia and ICU, San Paolo Hospital, Civitavecchia, Rome, Italy;
3 Unit of Anesthesia and ICU, European Hospital, Rome, Italy


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AIM: The increasing use of carotid artery stenting (CAS) is justified in patients at high-risk for carotid endarterectomy (CEA). The aim of this study was to evaluate the hypothesis that the high-risk patients can be submitted to CEA without increased risk of stroke and death.
METHODS: A retrospective analysis of 625 consecutive CEA in 545 patients (M/F 386/159, age 75±7) performed from January 2005 to December 2010 was carried out. Definite anatomical and pathophysiological high-risk cohort of patients (N.=173, 31.7%) was evaluated and compared to normal risk patients. Univariate, multivariate and Kaplan-Meier analysis were used as appropriate. Poisson regression (Pr) model was used to study all univariate criteria in combination. A P value <0.05 was statistically significant.
RESULTS: The overall 30-day stroke and death rate was 0.96%. No difference between high-risk vs. normal patient cohort regarding physiological and anatomical risk factors was detected. Univariate and multivariate analysis did not show statistical difference for 30-day outcome in any of the variables examined. No increase of risk in cases of presence of more risk factors resulted to the Pr analysis. The 24-month survival rate was worse in high-risk patients, especially when more physiologic risk as chronic renal failure, severe pulmonary and cardiac diseases and age over eighty were present.
CONCLUSION: CEA is a safe procedure in patients at high-risk carotid artery disease. A better classification of high-risk patients may be necessary because trials criteria appear ineffective to define the patients at real high surgical risk. Long-term outcome was affected by the presence of severe comorbidities.

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