INFLUENCE OF PATIENT-RELATED VARIABLES ON THE OUTCOME OF CAROTID ENDARTERECTOMY

Purpose: Variability in outcome after carotid endarterectomy is well r ecognized. This study examines the importance of patient-related facto rs in determining outcome. Methods: Four hundred and sixty consecutive patients undergoing carotid endarterectomy for symptomatic severe (60 % to 99%) internal carotid stenosis performed by one vascular surgeon have been studied prospectively. Patients were followed-up at 3, 6, 9, and 12 months and then yearly. Pre-, intra-, and perioperative detail s and follow-up information were entered on a database. Results: Multi ple logistic regression identified a number of factors significantly a ssociated with death and stroke. A history of crescendo transient isch emic attacks (TIAs) (p = 0.003, p = 0.0002) and being female (p = 0.03 , p = 0.0001) were associated with both perioperative death and stroke within 30 days of operation, respectively. Deaths between 1 and 36 mo nths were associated with ischemic heart disease (p = 0.03) and diabet es (p = 0.04), whereas stroke was associated with small internal carot id diameter (p = 0.02). The importance of symptoms at presentation on outcome was further emphasized by life-table analysis. In 98% of patie nts with amaurosis fugax, only 67% of those with crescendo TIAs were a live at 18 months (p < 0.01). The survival of patients with amaurosis was significantly better than those with TIAs (p < 0.01), transient st roke (p < 0.01), and progressive stroke (p < 0.05). Similarly, postope rative stroke was significantly more common for patients with crescend o TIAs than those with amaurosis (p < 0.01), established stroke (p < 0 .05), and TIA (p < 0.05). Transient stroke was associated with a poor outcome, with only 66% of patients being alive at 36 months and 14% ha ving suffered a stroke (p < 0.05 compared with established stroke). Co nclusion: Presenting symptoms significantly predict outcome after caro tid endarterectomy. This should be considered both in patient selectio n and comparison of patient series.