Carotid Artery Surgery in Diabetic Patients

We present a retrospective study of 191 carotid artery operations in which a large population of diabetic patients is compared with a smaller nondiabetic group of patients. Of the patients who were studied, 62.3% were diabetic and 37.6% were nondiabetic. The patients with a juvenile-onset diabetes fared poorly, with few of them living long enough to develop carotid artery disease. The patients with adult-onset diabetes differed from the nondiabetic patients only in the increased incidence of associated peripheral vascular disease. The incidence of symptomatic heart disease preoperatively, and the perioperative morbidity from heart disease was the same for both groups. The perioperative stroke rate was 2.6% and 0%, respectively, for asymptomatic patients. Long-term follow-up demonstrated the effectiveness of the procedure, with only two of the patients with transient ischemic attacks developing strokes later. There was, however, a highly significant increased death rate from myocardial infarction among the diabetic patients (55%), compared with the nondiabetic patients (25%).