Home > Riviste > The Journal of Cardiovascular Surgery > Fascicoli precedenti > The Journal of Cardiovascular Surgery 2012 June;53(3) > The Journal of Cardiovascular Surgery 2012 June;53(3):333-43

ULTIMO FASCICOLO
 

JOURNAL TOOLS

Opzioni di pubblicazione
eTOC
Per abbonarsi
Sottometti un articolo
Segnala alla tua biblioteca
 

ARTICLE TOOLS

Estratti
Permessi
Share

 

  VASCULAR SECTION 

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

Copyright © 2012 EDIZIONI MINERVA MEDICA

lingua: Inglese

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


PDF


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.

inizio pagina