(Stroke. 1997;28:891-898.)
© 1997 American Heart Association, Inc.
Articles |
Regional Performance of Carotid Endarterectomy
Appropriateness, Outcomes, and Risk Factors for Complications
From the Division of Neurosurgery, Department of Surgery (J.H.W., J.M.F.), and the Department of Public Health Sciences (M.E.S.-A.), MacKenzie Health Sciences Centre, University of Alberta, Edmonton, Canada.
Correspondence to J.M. Findlay, Division of Neurosurgery, Department of Surgery, 2D1.02 MacKenzie Health Sciences Centre, University of Alberta, 8440-112 St, Edmonton, AB, Canada, T6G 2B7. E-mail jmfind{at}planet.eon.net
Background and Purpose Guided by the findings of randomized controlled trials evaluating carotid endarterectomy (CEA), we examined the appropriateness of CEAs performed in our city and determined the incidences and risk factors for postoperative stroke, death, and cardiac complications.
Methods Using health records, we retrospectively
reviewed 291 consecutive CEAs performed in our region over 18 months.
Based on randomized controlled trial results and standardized
remeasurements of angiographic carotid stenoses, indications
for CEA were considered appropriate for symptomatic carotid
stenoses 
70%, uncertain for <70% symptomatic
or 60% asymptomatic stenoses, or inappropriate
for <60% asymptomatic stenoses and for patients
with preoperative neurological or medical instability.
Results We found that 41% of patients (118/291) were asymptomatic. Surgical indications were appropriate in 33% of cases (92/281), uncertain in 49% (138/281), and inappropriate in 18% (51/281). Stroke or death occurred within 30 days postoperatively in 5.2% (9/174) of symptomatic patients and 5.1% (6/117) of asymptomatic patients. At least one cardiac complication (angina, congestive heart failure, dysrhythmia, or myocardial infarction) developed in 8.9% (26/291). Independent preoperative risk factors for stroke or death were histories of angina or congestive heart failure and lack of antiplatelet medication; for cardiac complications, risk factors were age >75 years and a history of congestive heart failure.
Conclusions Almost 1 in 5 patients underwent CEA inappropriately, which was most commonly due to apparent overestimation of stenosis severity, and half had uncertain indications. Our high complication rate possibly negated any overall surgical benefit in the large group of asymptomatic patients.
Key Words: carotid endarterectomy • complications • health services misuse • risk factors
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