Ist Diabetes mellitus ein eigenständiger Risikofaktor in der Karotischirurgie?

Abstract

BackgroundThe status of diabetes mellitus as a predictor of poor outcome after carotid endarterectomy (CEA) is controversial. The objective of this study was to evaluate and compare the perioperative death and stroke rates after CEA in patients with and without diabetes.Material and methodsA retrospective analysis of 1,291 patients (mean age 68.6 years, SD 8.9 years; 920 men) undergoing CEA for carotid artery stenosis between January 1999 and January 2005 was performed.ResultsOf this study population, 28.4% (n=366) were diabetic. The same proportion of symptomatic patients was seen in both groups (48% diabetics vs. 43% nondiabetics; not significant). No differences regarding surgical technique, degree of stenosis, operating time, or clamping time were observed. Selective shunting was used significantly more often in diabetics (32%) than in nondiabetics (24%; p=0.002, odds ratio 1.535, 95% confidence interval 1.177–2.001). The perioperative stroke rate in diabetic patients was 3.8% (n=14/366) compared to 2.8% (25/925) in nondiabetic patients (p=0.343). The overall mortality was 0.54% (n=7/1,291); 0.27% (n=1) in diabetics and 0.62% (n=6) in nondiabetics (p=0.408). The combined death and stroke rate was 3.4% in diabetics versus 4.1% in nondiabetics (p=0.584).ConclusionIn this study, the presence of diabetes did not influence perioperative stroke and death rates after CEA. Shunt insertion was significantly more frequent in diabetic patients.