Enrico Sbarigia, Laura Capoccia, Anna Rita Rizzo, Chiara Pranteda, Nunzio Montelione, Francesco Speziale
Department of Surgery "P.Stefanini", Vascular Surgery Division, Policlinico Umberto I, University "La Sapienza", Roma, Italy.
OBJECTIVES: To report on the incidence of neurological complications following CEA in patients affected by carotid stenosis with contralateral occlusion (CO), to analyze factors associated to neurological complications in this group of patients, and to compare results between those patients and the whole group of patients submitted to CEA at our Vascular Division. Design: retrospective review of a prospectively-collected single-center database.
METHODS: From January 1997 to November 2012, 1,682 patients were consecutively submitted to CEA. One hundred thirty-nine presented a CO contralateral to the carotid stenosis. The 2 groups of patients were analyzed and compared respect to neurological death rates, major and minor stroke rates and TIA rates. Factors potentially affecting neurological results were analyzed and compared within each group and between groups. Statistical significance was set at p≤0.05.
RESULTS: Patients with CO were more frequently male, smokers, younger and symptomatic than those without CO (p<0.02). They presented more frequently a preoperative brain infarct and associated peripheral arterial disease (p<0.001). Patients with CO presented higher overall and major neurological complications rates compared to patients without CO (8.63% vs. 3.5%, p=0.006 and 5.75% vs. 1.94%, p=0.009, respectively). Factors associated to the highest risk in patients with CO were age>74 years and presence of preoperative brain infarct (p<0.04). The association of CO, age>74 years and preoperative brain infarct significantly increase the risk of post-CEA neurological complication occurrence in the population submitted to CEA (OR 21.9; 95% CI 6.6-74, p<0.0001).
CONCLUSIONS: Patients presenting a carotid stenosis with CO are at high neurological risk when submitted to CEA. In this group of patients, those presenting>74 years of age and a preoperative brain infarct represent a subset at highest neurological risk following CEA.
AUTHOR DISCLOSURES: L. Capoccia: Nothing to disclose; N. Montelione: Nothing to disclose; C. Pranteda: Nothing to disclose; A. Rizzo: Nothing to disclose; E. Sbarigia: Nothing to disclose; F. Speziale: Nothing to disclose.
Posted April 2013