Endarterectomy Outcomes Not Stenosis-Driven

PHILADELPHIA — Carotid endarterectomy outcomes were comparable between patients with asymptomatic, 60%–69% carotid stenosis and those with more than that, a review of more than 6,000 patients showed.

“The degree of carotid stenosis does not appear to influence outcome,” Dr. Leon Salem said at the annual meeting of the Eastern Vascular Society. For example, the incidence of perioperative neurologic deficits was 3% in the 102 patients with 60%–69% stenosis, compared with rates of 1.8%–2.9% among patients with more severe carotid stenosis (up to 99%). Between-group differences were not statistically significant.

Guidelines recommend carotid endarterectomy for asymptomatic patients with 60% or greater carotid stenosis and low surgical risk (J. Vasc. Surg. 2008;48:480–6), but it is not commonly done on patients with less than 70% stenosis, according to Dr. Salem, a vascular surgeon at Albany (N.Y.) Medical Center.

His study reviewed 6,379 asymptomatic patients having carotid endarterectomy at Albany Medical Center from 1994 to 2008, with an average age of 70. Of those, 51% had a 90%–99% stenosis, 35% had an 80%–89% stenosis, and 12% had a 70%–79% stenosis.

The incidence of perioperative death ranged from no deaths in the 60%–69% group to a 0.7% mortality rate in those with 90%–99% stenosis. The perioperative rate of permanent neurologic deficit ranged from 1.0% in the 60%–69% patients to 0.4% in those with 80%–89% obstructed. Temporary neurologic deficits ranged from 2.2% in the 70%–79% group to 1.4% in the 80%–89% patients.