Carotid artery endarterectomy in patients with severe strokes (mRS ≥3) resulted in similar 30-day rates of perioperative stroke, mortality, and readmission compared to patients with mRS <3.
Cohort (n=1,013)
Does stroke severity (mRS ≥3 vs mRS <3) affect 30-day postoperative outcomes in patients undergoing carotid artery endarterectomy?
Patients with more severe strokes (mRS ≥3) have similar short-term perioperative complication rates following carotid endarterectomy compared to those with less severe strokes, despite having more preoperative comorbidities.
BackgroundCarotid artery endarterectomy (CEA) is recommended to reduce stroke risk in patients following nondisabling ischemic stroke (modified Rankin Score mRS<3). We reviewed CEA outcomes in patients after more devastating strokes (mRS≥3).MethodsAn observational cohort study was performed, and data were collected from 1013 CEA cases over 15 years. Patient demographics, comorbidities and postoperative outcomes were compared between preoperative mRS<3 (Group 1) and mRS≥3 (Group 2). Statistical significance was determined by P < 0.05.ResultsNinety-one (9%) patients were mRS ≥3. There was no significant difference between age, gender, and operated side. Group 2 had significantly higher rates of diabetes and frailty. There was no significant difference in anesthetic type. Group 2 spent longer in High Dependency. Return to theater and postoperative complications were similar. Incidence of perioperative stroke, mortality, and readmission rates were not significant at 30 days postoperation between the 2 groups.ConclusionsPatients with a higher mRS have more preoperative comorbidities but short-term perioperative complication rate is not significantly different. Patient selection should be undertaken with care. Carotid artery endarterectomy (CEA) is recommended to reduce stroke risk in patients following nondisabling ischemic stroke (modified Rankin Score mRS<3). We reviewed CEA outcomes in patients after more devastating strokes (mRS≥3). An observational cohort study was performed, and data were collected from 1013 CEA cases over 15 years. Patient demographics, comorbidities and postoperative outcomes were compared between preoperative mRS<3 (Group 1) and mRS≥3 (Group 2). Statistical significance was determined by P < 0.05. Ninety-one (9%) patients were mRS ≥3. There was no significant difference between age, gender, and operated side. Group 2 had significantly higher rates of diabetes and frailty. There was no significant difference in anesthetic type. Group 2 spent longer in High Dependency. Return to theater and postoperative complications were similar. Incidence of perioperative stroke, mortality, and readmission rates were not significant at 30 days postoperation between the 2 groups. Patients with a higher mRS have more preoperative comorbidities but short-term perioperative complication rate is not significantly different. Patient selection should be undertaken with care.
Cruddas et al. (Mon,) conducted a cohort in Ischemic stroke (n=1,013). Carotid artery endarterectomy in patients with mRS ≥3 vs. Carotid artery endarterectomy in patients with mRS <3 was evaluated on Incidence of perioperative stroke, mortality, and readmission rates at 30 days postoperation. Carotid artery endarterectomy in patients with severe strokes (mRS ≥3) resulted in similar 30-day rates of perioperative stroke, mortality, and readmission compared to patients with mRS <3.