Abstract
ObjectivesSeveral studies have shown the beneficial role of statins in reducing the risk of major perioperative complications and death associated with noncardiac vascular surgery, but few have focused on their effects in the event of carotid endarterectomy (CEA). This study analyzes the effects of preoperative statin use on perioperative outcomes in patients undergoing CEA.Materials and MethodsData from all consecutive patients who underwent primary CEA for symptomatic and asymptomatic carotid disease between 2002 and 2014 at a single institution were prospectively stored in a vascular surgery registry, recording risk factors, medication, and indication for surgery. Endpoints of the study were perioperative (30‐day) stroke and death.ResultsOverall, 784 patients were on statins (825 CEAs, Group I), while 494 were not (545 CEAs, Group II). There were two perioperative strokes in Group I (0.24%) and four in Group II (0.73%; p = .22), and no deaths. The only nonfatal cardiac complication occurred in Group II (0.18%, p = .39). A neurologist assessed patients at 1, 6, and 12 months after CEA, and every 2 years thereafter. Follow‐up (range: 0.1–13 years; mean, 6.3 ± 3.7 years) was obtained for 1,239 patients (1,326 CEAs). Because 165 patients (166 CEAs) crossed over from Group II to Group I during the follow‐up time, long‐term data were stratified by postoperative statin treatment rather than by preoperative statin use. The 5‐ and 10‐year restenosis/occlusion and survival rates did not differ significantly between the two groups.ConclusionsTaking statins prior to CEA did not seem to affect the risk of major perioperative ischemic events and death, most likely due to the extremely low overall incidence of perioperative complications.
Highlights
Carotid endarterectomy (CEA) remains the “gold standard” treatment for severe symptomatic and asymptomatic carotid disease with a view to preventing cerebrovascular ischemic events (Chambers, You, & Donnan, 2005; Rothwell et al, 2003)
Since the first large randomized controlled trials (RCTs) were conducted (Executive Committee for the Asymptomatic Carotid Atherosclerosis Study, 1995; North American Symptomatic Carotid Endarterectomy Trial Collaborators, 1991), significant improvement has been made in the medical management of patients with atherosclerotic carotid disease and there is compelling evidence of a drop in the risk of cerebral
The results of our study showed that using statins before CEA did not significantly affect the incidence of perioperative cerebral ischemic events or death, when considered as independent variables or examined in combination
Summary
Carotid endarterectomy (CEA) remains the “gold standard” treatment for severe symptomatic and asymptomatic carotid disease with a view to preventing cerebrovascular ischemic events (Chambers, You, & Donnan, 2005; Rothwell et al, 2003). Since the first large randomized controlled trials (RCTs) were conducted (Executive Committee for the Asymptomatic Carotid Atherosclerosis Study, 1995; North American Symptomatic Carotid Endarterectomy Trial Collaborators, 1991), significant improvement has been made in the medical management of patients with atherosclerotic carotid disease and there is compelling evidence of a drop in the risk of cerebral.
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