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(Stroke. 2003;34:2568.)
© 2003 American Heart Association, Inc.

Original Contributions

Risk Factors for Death or Stroke After Carotid Endarterectomy

Observations From the Ontario Carotid Endarterectomy Registry

Jack V. Tu, MD, PhD; Hua Wang, PhD; Beverley Bowyer, RN; Lawrence Green, MD; Jiming Fang, MSc Daryl Kucey, MD, MSc, MPH for the Participants in the Ontario Carotid Endarterectomy Registry

From the Institute for Clinical Evaluative Sciences (J.V.T., H.W., J.F.); Divisions of General Internal Medicine (J.V.T.) and Vascular Surgery (B.B., L.G., D.K.), Sunnybrook and Women’s College Health Sciences Centre; and Department of Medicine, University of Toronto (J.V.T.), Toronto, Ontario, Canada.

Reprint requests to Dr Jack V. Tu, Institute for Clinical Evaluative Sciences, G106–2075 Bayview Ave, Toronto, Ontario, M4N 3M5, Canada. E-mail tu{at}ices.on.ca

Background and Purpose— Carotid endarterectomy is an effective method for preventing strokes if patients do not suffer adverse perioperative outcomes. The purpose of this study was to identify preoperative patient risk factors for adverse outcomes (death or nonfatal stroke) after carotid endarterectomy through the use of a large population-based registry from Ontario, Canada.

Methods— Medical records of all 6038 patients who underwent carotid endarterectomy in Ontario between January 1, 1994, and December 31, 1997, were abstracted from 34 hospitals. Patient characteristics (demographic data, past medical history, neurological symptoms, comorbidities, radiological findings) and 30-day postoperative death or stroke rates were analyzed with logistic regression analysis.

Results— The overall 30-day death or stroke rate after surgery was 6.0%. A history of transient ischemic attack or stroke (odds ratio [OR], 1.75; 95% confidence interval [CI], 1.39 to 2.20), atrial fibrillation (OR, 1.89; 95% CI, 1.29 to 2.76), contralateral carotid occlusion (OR, 1.72; 95% C.I., 1.25 to 2.38), congestive heart failure (OR, 1.80; 95% CI, 1.15 to 2.81), and diabetes (OR, 1.28; 95% CI, 1.01 to 1.63) were significant independent predictors for 30-day death or stroke. These 5 factors were combined into a simple risk score that can be used to stratify patients into different risk groups for complications after surgery.

Conclusions— Several patient characteristics predict the development of stroke and death after carotid endarterectomy. These characteristics may help clinicians in patient counseling and contribute to studies benchmarking the outcomes of carotid surgery in the community setting.

Key Words: carotid endarterectomy • carotid stenosis • Ontario • risk factors • stroke

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