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Home > Vascular Annual Meeting > RR2. Do Anatomical Risk Factors Cause...

RR2. Do Anatomical Risk Factors Cause Patients to be at High Risk for Carotid Endarterectomy?

Sachinder S Hans1, Olan Jareunpoon1, Debbie DeSantis1, Bijaya Hans2
1Henry Ford Macomb Hospital, Clinton Twp., MI; 2VA  Medical Center, Detroit, MI

OBJECTIVES: The Center for Medicare and Medicaid Services (CMS) has been asked to consider anatomic risks factors that cause patients to be high risk for carotid endarterectomy (CEA). We evaluated the results of CEA in patients with anatomic high risk factors.

METHODS: From an ongoing carotid endarterectomy registry (2003-2008) of 579 patients, 100 had anatomic factors leading to their inclusion in the high risk category for carotid endarterectomy (17.2%) including:

1. Previous carotid endarterectomy with recurrent stenosis, n=32.
2. Carotid endarterectomy in the presence of contralateral carotid occlusion, n=23.
3. Carotid endarterectomy for carotid stenosis located above C2 vertebra (high plaque), n=41.
4. Contralateral vocal cord palsy, radical neck dissection, prior radiation to neck or laryngectomy, n=4.

The primary end point was perioperative stroke/death or myocardial infarction (MI) in 30 days and occurrence of stroke/death between 31 days and 52 months (Kaplan-Meier analysis). Minor stroke was defined as functional deficit with full recovery within three months or major stroke with minimal/no recovery after three months. The majority of CEAs (over 90%) were performed under cervical block anesthesia.

RESULTS:

Table 1.

*significant

Table 2. Incidence of Adverse Affects Within 30 Days

†Major stroke resulted in death in two patients.
‡MI and death in two patients.
During late follow up, three patients had ipsilateral stroke, one had contralateral stroke in the remaining group and no patients in the anatomic high risk had late stroke (ns).

CONCLUSIONS: Results of carotid endarterectomy in patients with anatomic high risk factors are similar to those performed on patients without high risk factors.

AUTHOR DISCLOSURES: S.S. Hans, None; O. Jareunpoon, None; D. DeSantis, None; B. Hans, None.