Gender-related risk factors for perioperative stroke after carotid endarterectomy in symptomatic patients.

BACKGROUND: Carotid endarterectomy (CEA) is a surgical procedure used in ischemic brain stroke prevention in patients with symptomatic and asymptomatic severe carotid artery stenosis. OBJECTIVES: This study compares perioperative stroke or death rate after carotid endarterectomy (CEA) in male and female patients, and determines risk factors for perioperative incidents in women and men. MATERIAL AND METHODS: The outcome of surgical treatment of 269 consecutive symptomatic patients (181 men and 88 women) treated from January 2004 to August 2008 in the Department of Vascular, General and Oncologic Surgery was analyzed. RESULTS: Perioperative stroke-death rate (within 30 days after the surgery) in women was 6.8% (6/88) and 3.3% (6/181) in men (p > 0.05). In the female group, none of the analyzed risk factors were associated with a higher risk of periprocedural incident, while in men, only hypercholesterolemia was a significant predictor of perioperative stroke (TC > 240 vs 240 vs 200-240: OR = 6.59; 95% CI: 1.12-38.97; p = 0.0375). CONCLUSIONS: In men, hypercholesterolemia significantly increased the risk of perioperative stroke or death, while in females, none of the analyzed factors were determined as the predictors of the incident. The fact that plaque type VI by AHA was significantly more frequent in women and men more frequently were suffering from ischemic heart disease and peripheral artery occlusive disease appeared not to influence the outcome of CEA.

Influence of internal carotid endarterectomy on patients' life quality.

UNLABELLED: Appropriate treatment of symptomatic carotid artery stenosis can reduce ischemic cerebral strokes' risk and in some cases eliminate neurological symptoms. Endarterectomy is the most common surgical treatment. The aim of the study was to examine the influence of carotid endarterectomy on neurological symptoms and patients' life quality. MATERIAL AND METHODS: The material comprised of 102 patients who underwent endarterectomy. All of the patients were given a questionnaire with a list of neurological symptoms (vertigos, headaches, left hemiparesis, right hemiparesis, numbness, acroparaesthesia, single syncope, recurrent syncopies, diplopia, tinnitus, concentration disturbances and aphasia) and with a numerical life quality scale to fill in before and a year after the surgery. RESULTS: Vertigo, headache, single and recurrent syncopies and aphasia as well as cerebral stroke and amaurosis fugax were significantly more rarely observed after endarterectomy. The mean value of patients' life quality evaluated on a 10-point Likert scale after the surgery increased (3.9 vs 6.3). CONCLUSIONS: A year after carotid endarterectomy patients' life quality improves which is connected with neurological symptoms' regression and no further symptoms' occurrence due to a preventive role of the surgery.

Intracranial occlusions and internal carotid artery stenoses: clinical implications.

BACKGROUND: The aim of this research was to investigate the influence of intracranial stenoses or occlusions on the outcome of carotid endarterectomy (CEA) in patients with internal carotid artery stenosis. The authors also searched for internal carotid artery plaque's morphology influence on the atherosclerotic process in intracranial arteries. METHODS: The study included 154 patients who underwent angiography and CEA. Intracranial lesions (stenosis or occlusion) were stated in 28 (18.2%) patients. RESULTS: Perioperative stroke - death rate was 3.9%. Statistical analysis revealed that perioperative stroke after CEA appeared significantly more often in patients with intracranial stenoses or occlusions (p = 0.0104). Late death-stroke rate was 13.6%. Log-rank test revealed that after a 1-year follow-up period, there were significantly more survivals in patients without intracranial lesions than in those with intracranial lesions (p = 0.048). CONCLUSIONS: Intracranial stenosis or occlusion predicts poor perioperative neurological outcome. Patients with intracranial lesions benefit less from endarterectomy in a 1-year follow-up period. On the basis of internal carotid artery plaque's morphology, no conclusions on advancement of intracranial arteries' atherosclerosis can be made.