Does Modified Rankin Score (mRS) Matter? The Impact of Stroke Severity on Carotid Artery Endarterectomy (CEA) Outcomes

Abstract

Carotid artery endarterectomy (CEA) is recommended to reduce stroke risk in patients following non-disabling ischaemic stroke (modified Rankin Score mRS<3). We reviewed CEA outcomes in patients after more devastating strokes (mRS≥3). An observational cohort study was performed, and data was collected from 1013 CEA cases over fifteen years. Patient demographics, co-morbidities and post-operative outcomes were compared between preoperative mRS<3 (Group one) and mRS≥3 (Group two). Statistical significance was determined by p<0.05. Ninety-one (9%) patients were mRS ≥ 3. There was no significant difference between age, gender, and operated side. Group two had significantly higher rates of diabetes and frailty. There was no significant difference in anaesthetic type. Group two spent longer in High Dependency. Return to theatre and post-operative complications were similar. Incidence of perioperative stroke, mortality and readmission rates were not significant at 30 days post-operation between the two groups. Patients with a higher mRS have more pre-operative co-morbidities but short-term perioperative complication rate is not significantly different. Patient selection should be undertaken with care.