JOURNAL ARTICLE
Add like
Add dislike
Add to saved papers

High-risk carotid endarterectomy: fact or fiction.

OBJECTIVE: It has been proposed that patients whose conditions do not meet North American Symptomatic Carotid Endarterectomy Trial inclusion criteria or have anatomic risk factors constitute a "high-risk" group for carotid endarterectomy (CEA) and might be candidates for primary carotid angioplasty stenting. Our objective was to review a consecutive series of isolated CEAs, identify the number of such patients at high risk, and determine whether their operations were associated with increased complication rate.

METHODS: Consecutive isolated CEAs performed between June 1996 and June 2001 were reviewed. High-risk comorbidities included: age 80 years or more (n = 80), New York Heart Association class III/IV angina (n = 16), Canadian class III/IV heart failure (n = 4), myocardial infarct 6 months or less (n = 11), steroid-dependent or oxygen-dependent pulmonary disease (n = 4), and creatinine level of 3 or more (n = 13). Anatomic high risk was defined by: contralateral occlusion (n = 66), lesion above C(2) or requirement of digastric division (n = 53), reoperation (n = 29), and neck radiation (n = 3). Statistical analysis was with chi(2) analysis.

RESULTS: Of 788 patients reviewed, 228 (29%) were classified as high risk by one or more of the previous criteria (63% comorbidity, 28% anatomy, 9% both). Presence of preoperative neurologic symptoms and postoperative results were similar across all patient groups. The total stroke and death rate was 1.1% for all the patients. Six patients had postoperative strokes (0.8%), and three patients died of myocardial infarcts (0.4%). The stroke and death rate was 1.3% in the high-risk group as compared with 1.1% in the normal-risk group (P =.51).

CONCLUSION: The concept of the high-risk CEA must be critically reexamined. Although 29% of patients for CEA were high risk as defined by others, we found no evidence that this influenced the results after CEA. Patients with significant medical comorbidities, contralateral carotid occlusion, and high carotid lesions can undergo operation without increased complications. If a high-risk group exists, it is small and restricted to reoperation or radiated neck (4% in this series). With this possible exception, carotid angioplasty stenting should be restricted to randomized clinical trials.

Full text links

For the best experience, use the Read mobile app

Group 7SearchHeart failure treatmentPapersTopicsCollectionsEffects of Sodium-Glucose Cotransporter 2 Inhibitors for the Treatment of Patients With Heart Failure Importance: Only 1 class of glucose-lowering agents-sodium-glucose cotransporter 2 (SGLT2) inhibitors-has been reported to decrease the risk of cardiovascular events primarily by reducingSeptember 1, 2017: JAMA CardiologyAssociations of albuminuria in patients with chronic heart failure: findings in the ALiskiren Observation of heart Failure Treatment study.CONCLUSIONS: Increased UACR is common in patients with heart failure, including non-diabetics. Urinary albumin creatininineJul, 2011: European Journal of Heart FailureRandomized Controlled TrialEffects of Liraglutide on Clinical Stability Among Patients With Advanced Heart Failure and Reduced Ejection Fraction: A Randomized Clinical Trial.Review

Get seemless 1-tap access through your institution/university

For the best experience, use the Read mobile app

Read by QxMD is copyright © 2021 QxMD Software Inc. All rights reserved. By using this service, you agree to our terms of use and privacy policy.

Get seemless 1-tap access through your institution/university

For the best experience, use the Read mobile app