[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.

[Results of carotid endarterectomy in diabetic patients]. / Serganciuju cukriniu diabetu vidines miego arterijos endarterektomijos rezultatai.

UNLABELLED: Patients with diabetes mellitus have been shown to have an increased incidence of complications after major vascular surgery. The objective of this study was to evaluate the results of carotid endarterectomy in diabetic patients, to determine if results differ from nondiabetic patients, and to examine the risk factors for poor outcome among diabetic patients. MATERIAL AND METHODS: We reviewed all carotid endarterectomies performed in Emergency Hospital of Vilnius University. From 1995 to 2005, 707 carotid endarterectomies were performed. Of these, 100 operations were performed in diabetic patients (14%) and the remaining 607 in nondiabetic patients. RESULTS: Diabetic patients were younger (P<0.05) and were obese more often (P<0.001), they smoked less often (P<0.001) than nondiabetic patients. Diabetics were more likely to have severe bilateral carotid stenosis than nondiabetic patients (P<0.01). Postoperative complications (stroke) were more common in diabetic patients than in nondiabetic patients (12.0% vs. 3.4%, P<0.001) as well as intracerebral hemorrhages (3.0% vs. 0.3%, P<0.001); no perioperative myocardial infarction was found in diabetic patients. Risk factors for complications were age >/=75 (odds ratio (OR) 2.2; 95% confidence interval (CI)=1.0-4.9), smoking (OR 2.7; 95% CI=1.8-4.2), obesity (OR 6.1; 95% CI=3.9-9.5), and bilateral carotid stenosis (OR 2.1; 95% CI=1.3-3.6). CONCLUSION: Diabetes mellitus significantly increased the risk of mortality and intracerebral hemorrhage but not myocardial infarction. It should be taken into consideration in making decisions about the performance and perioperative management of carotid endarterectomy.

[Carotid artery atherosclerotic stenosis, plaque structure and stroke]. / Vidines miego arterijos aterosklerozine stenoze, ploksteles struktura ir galvos smegenu insultas.

OBJECTIVES: The main indication for carotid endarterectomy is severity of stenosis carotid artery. Several studies have shown the relationship between carotid plaque morphology and cerebrovascular disorders. The purpose of this study was to evaluate the structure of carotid plaque and correlate carotid plague morphology with neurological symptoms, stroke risk factors, severity of carotid stenosis and operative stroke. METHODS: Operative specimens of 262 carotid plaques were examined macroscopically. Plague morphology was characterized as either heterogeneous or homogeneous. Stroke risk factors, cerebrovascular symptoms, severity of carotid stenosis and risk for mortality and operative stroke were compared between symptomatic and asymptomatic patients with heterogeneous and homogeneous plague. RESULTS: Heterogeneous plaques were present in 198 (75%) of 262 arteries. Heterogeneous plaques were found in 121 symptomatic and 77 asymptomatic patients (p<0.001). Homogeneous plagues did not differ in symptomatic and asymptomatic patients. The structure of plaque did not correlate with any severity of stenosis. There were no significant differences in age, sex, smoking and arterial hypertension between heterogeneous and homogeneous groups. Higher level of fibrinogen but not hypercholesterolemia was associated with heterogeneity of plaque. Postoperative stroke was mainly present in the patients with heterogeneous plaques, but the difference was not statistically significant. CONCLUSIONS: Heterogeneous plaques were present in 75 % of patients with carotid artery stenosis. Heterogeneous plagues were associated with cerebrovascular symptoms more often than homogeneous ones. Plague structure did not correlate with severity of carotid artery stenosis and operative stroke was not associated with plaque heterogeneity. These findings suggest that plague heterogeneity should be considered in selecting patients for 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.