[Risk of stroke and death after carotid endarterectomy]. / Galvos smegenu insulto ir mirties rizika po vidines miegoarterijos endarterektomijos.

OBJECTIVE: The benefit of carotid endarterectomy is highly dependent on surgical risk. The aim of this study was to evaluate the incidence of stroke and death after carotid endarterectomy, risk factors for poor outcomes, and importance of surgeon's competence. MATERIAL AND METHODS: A total of 790 carotid endarterectomies performed in the Vilnius University Emergency Hospital between 1995 and 2006 were analyzed. Risk factors, neurological symptoms, comorbidities, radiologic and angiographic findings, morbidity and mortality, experience and volume of a vascular surgeon were prospectively recorded in a database. Univariate and multivariable logistic regression and receiver operating characteristic curves were used to analyze the data. RESULTS: Among the 790 cases studied, in-hospital mortality was 2.2%, and stroke morbidity was 2.4%. Postoperative complications were more common in patients with diabetes mellitus than without (12% vs. 3.4%, P<0.001) and in patients with any stroke than in patients with nonspecific symptoms (10.7% vs. 1.4%, P<0.02). The postoperative stroke rate was 10% for a surgeon who performed <6 carotid endarterectomies per year and 4.6% for a surgeon who performed ≥6 carotid endarterectomies (P=0.02). In the multivariate logistic regression, combined mortality and stroke was independently predicted by diabetes mellitus (OR, 3.51; 95% CI, 1.60-7.66; P=0.002), any stroke (OR, 4.14; 95% CI, 1.57-10.91; P=0.004), and low-volume surgeon (OR, 0.32; 95% CI, 0.13-0.78; P=0.013). The receiver operating characteristic curve analysis showed an overall predicting value of 0.72. CONCLUSIONS: Diabetes mellitus, any stroke, and low-volume vascular surgeon were significant predictors for poor outcome after carotid endarterectomy.

[Complications of carotid endarterectomy]. / Miego arterijos endarterektomijos komplikacijos.

BACKGROUND AND PURPOSE: Carotid endarterectomy has been shown to be beneficial in patients with high-grade carotid stenosis. This benefit will be realized only if the operation is performed safely. We determined the ratio of operative complications and sought to identify the risk factors for operative stroke and death from carotid endarterectomy. METHODS: Two hundred fifty seven patients underwent carotid endarterectomy during 1995-1999 years in Vilnius emergency hospital. Nineteen potential risk factors for operative complications were examined. RESULTS: Mortality of endarterectomy was 2.7%, the overall risk of stroke and/or death was 4.3%. In multivariate logistic-regression models a symptom status (recent history of stroke) and angiographic features (contralateral stenosis 70% and more) were as independent risk factors for operative stroke and death. CONCLUSIONS: The risk of stroke and death from carotid endarterectomy is related to clinical and angiographic characteristics. These observations may help clinicians to estimate operative risks for individual patients.