(Stroke. 1999;30:1759-1763.)
© 1999 American Heart Association, Inc.
Original Contributions |
Medical Complications Associated With Carotid Endarterectomy
From the John P. Robarts Research Institute (M.P., M.E., L.J.K., J.W.F., H.J.M.B) and the Departments of Epidemiology and Biostatistics (M.E.) and Clinical Neurological Sciences (M.E., G.G.F., H.J.M.B.), University of Western Ontario, London, Ontario, Canada.
Correspondence to Dr H.J.M. Barnett, John P. Robarts Research Institute, PO Box 5015, 100 Perth Dr, London, ON N6A 5K8, Canada. E-mail barnett{at}rri.on.ca
Background and Purpose—Carotid endarterectomy (CE) has been shown to be beneficial in patients with symptomatic high-grade (70% to 99%) internal carotid artery stenosis. To achieve this benefit, complications must be kept to a minimum. Complications not associated with the procedure itself, but related to medical conditions, have received little attention.
Methods—Medical complications that occurred within 30 days after CE were recorded in 1415 patients with symptomatic stenosis (30% to 99%) of the internal carotid artery. They were compared with 1433 patients who received medical care alone. All patients were in the North American Symptomatic Carotid Endarterectomy Trial (NASCET).
Results—One hundred fifteen patients (8.1%) had 142 medical
complications: 14 (1%) myocardial infarctions, 101 (7.1%) other
cardiovascular disorders, 11 (0.8%) respiratory
complications, 6 (0.4%) transient confusions, and 10 (0.7%) other
complications. Of the 142 complications, 69.7% were of short duration,
and only 26.8% prolonged hospitalization. Five patients died: 3 from
myocardial infarction and 2 suddenly. Medically treated patients
experienced similar complications with one third the frequency.
Endarterectomy was 
1.5 times more likely to
trigger medical complications in patients with a history of myocardial
infarction, angina, or hypertension (P<0.05).
Conclusions—Perioperative medical complications were observed in slightly fewer than 1 of every 10 patients who underwent CE. The majority of these complications completely resolved. Most complications were cardiovascular and occurred in patients with 1 or more cardiovascular risk factors. In this selected population, the occurrence of perioperative myocardial infarction was uncommon.
Key Words: carotid endarterectomy • clinical trials • complications
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