Predictive Factors for 30-Day Stroke and Death Rate in a Contemporary Series of Carotid Endarterectomies Performed for Asymptomatic Stenosis of the Internal Carotid Artery

Abstract

The objective was to retrospectively analyze the perioperative outcomes of carotid endarterectomy (CEA) performed for asymptomatic carotid stenosis in the last decade and to identify predictors of increased risk of stroke and death in a single-center experience. From January 2008 to December 2018, 2501 consecutive CEAs were performed in a single academic institution. Data concerning these interventions were prospectively collected in a dedicated database. A retrospective analysis of the database was performed, and 1956 interventions performed in asymptomatic patients were found. Univariate and multivariate (forward logistic regression) analyses were used to identify potentially significant predictors of stroke and death rate at 30 days and to calculate their weight in determining it. Thirty-day stroke and death rates were then assessed for each subgroup of different predictors. Overall, 30-day stroke and death rate was 0.9% (17 cases). On multivariate analysis, male sex, diabetes, and combined cardiac surgery and the need for selective shunting were identified as independent predictors of stroke and death at 30 days; 22.3% of patients did not have any predictor, whereas 51.3%, 23.1%, and 3.2% of the patients had one, two, or three predictors, respectively. No patient had four predictors. Thirty-day stroke and death rate for patients without any of the identified predictors was 0.2% (1 case/436 interventions), whereas the corresponding figures for patients with one, two, or three predictors were 0.7% (7 cases/1006 interventions; P = .7 in comparison with patients with no predictors), 1% (4 cases/451 interventions; P = .1 in comparison with patients with no predictors and P = .7 in comparison with patients with one predictor), and 8.5% (5 cases/63 interventions; P < .001 in comparison with patients with no predictor, one predictor, or two predictors). A subgroup of asymptomatic patients undergoing CEA with a prohibitive perioperative risk does exist, thus questioning the indication for surgery in such patients.