Carotid endarterectomy safe and effective in medically high-risk veterans

Patients who are considered “high risk” can undergo carotid endarterectomy just as safely as other patients, results of a study indicate.

Patients who are considered “high risk” can undergo carotid endarterectomy (CEA) just as safely as other patients, and the operation is successful in preventing stroke essentially for the rest of their lives, results of a study published in the August issue of the¬†Journal of the American College of Surgeons¬†indicate.

“There is a current debate regarding the usage of a new technology, angioplasty and stenting, and how to apply it for carotid disease,” Dr. Alan Dardik, of Yale University School of Medicine, New Haven, Connecticut, said in an interview with Reuters Health.

“Carotid disease can cause stroke and is typically treated with surgery, ie, with carotid endarterectomy,” he explained. “However, some would advocate for use of angioplasty and stenting in preference to surgery in high-risk patients, ie, those patients that are too risky for surgery since they have too many other severe medical problems.”

In the current study, Dr. Dardik and colleagues examined the safety and long-term efficacy of CEA in veterans, a medically high-risk group of patients with multiple comorbidities.

A total of 128 CEAs were performed in 120 patients over a five-year period in the Connecticut Veterans Affairs hospital. The mean follow-up time was 8.5 years.

Overall, 52 per cent of the patients were symptomatic on presentation. There was a high preoperative prevalence of hypertension (83 per cent), coronary artery disease (64 per cent), peripheral arterial disease (43 per cent), diabetes (37 per cent), renal disease (33 per cent), and COPD (22 per cent).

The incidences of perioperative death (0.8 per cent), stroke (1.6 per cent), myocardial infarction (0.8 per cent), arrhythmias (2.4 per cent), and congestive heart failure (0.8 per cent) were low.

The survival rates at 8.9 years and 12 years were 50 per cent and 13 per cent, respectively.

At one, five, and 12 years, 97 per cent, 93 per cent, and 90 per cent of patients, respectively, were free from ipsilateral stroke.

“Surgical therapy is exceptionally safe and effective in preventing stroke – even in medically high-risk patients,” Dr. Dardik concluded in his comments to Reuters Health. “High-risk patients should not shy away from surgery just because they are high risk.”