Postoperative Complications After Carotid Endarterectomy

Allan S. Brett, MD reviewing Bennett KM et al. J Vasc Surg 2015 Jan.

The 30-day rate of stroke or death was 3% in a large U.S. cohort.

Perioperative complications — especially stroke or death — are key considerations when patients consider carotid endarterectomy. In this study, researchers used a national surgical database to determine rates and predictors of postoperative stroke and death among 3845 patients who underwent carotid endarterectomy at 78 U.S. medical centers in 2012. Carotid stenosis was symptomatic in 42% of patients and asymptomatic in 58%.

The 30-day incidence of postoperative stroke or death was 3% overall — 4.6% in patients with symptomatic stenosis and 1.9% in those with asymptomatic stenosis. In multivariate analysis, independent predictors of stroke or death among symptomatic patients were emergency surgery, contralateral carotid stenosis of 80% to 99%, previous stroke (as opposed to transient ischemic attack), and one or more “physiologic high-risk characteristics” (as defined by the American College of Surgeons; these included cardiac, pulmonary, and renal comorbidities). Among asymptomatic patients, independent predictors were contralateral stenosis of 80% to 99% and American Society of Anesthesiologists class 4 or 5. The 30-day incidence of nonstroke major complications was 5.3%.

Citation(s):

Bennett KM et al. Predictors of 30-day postoperative stroke or death after carotid endarterectomy using the 2012 carotid endarterectomy-targeted American College of Surgeons National Surgical Quality Improvement Program database. J Vasc Surg 2015 Jan; 61:103.