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Outcomes/Effectiveness Research

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Certain clinical and surgical factors affect a patient's risk of death or stroke following carotid endarterectomy

Carotid endarterectomy, surgical removal of plaque from the carotid artery in the neck, is done to prevent strokes or stroke recurrence. Despite guidelines for selecting appropriate patients for the procedure, nearly 11 percent of patients appear to be inappropriately selected to undergo the surgery. A new study, supported in part by the Agency for Healthcare Research and Quality (HS09754), may help improve selection of candidates for carotid endarterectomy and identify patients in need of closer monitoring after surgery.

Researchers retrospectively studied 1,972 patients treated by 64 surgeons at 6 hospitals who underwent carotid endarterectomy in 1997 and 1998. They analyzed patients' medical records to identify clinical, radiographic, surgical, anesthesia, and medical management variables associated with deaths or strokes within a month of surgery.

The researchers found that, after adjustment for other factors affecting the likelihood of postoperative complications, three clinical factors doubled or tripled the odds of complications (strokes or death) within 30 days of surgery. These were stroke as the indication for surgery, presence of active coronary artery disease, and contralateral carotid narrowing of 50 percent or more.

Death or stroke occurred in 2.28 percent of patients without carotid symptoms, 2.93 percent of those with carotid transient ischemic attacks (mini strokes), and 7.11 percent of those who underwent the surgery due to stroke. On the other hand, two surgical techniques, local anesthesia and patch closure, reduced the odds of death or stroke by 70 and 57 percent, respectively.

Further information can be found in "Clinical and operative predictors of outcomes of carotid endarterectomy," by Ethan A. Halm, M.D., M.P.H., Edward L. Hannan, Ph.D., Mary Rojas, Ph.D., and others, in the September 2005 Journal of Vascular Surgery 42, pp. 420-428.

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