COMPUTERIZED-TOMOGRAPHY FINDINGS AS A RISK FACTOR IN CAROTID ENDARTERECTOMY - EARLY AND LATE RESULTS

Objectives: To evaluate whether preoperative CT evidence of brain infa rction is associated with an increased risk of early and late stroke a nd death in patients undergoing CEA. Design: Retrospective clinical st udy. Materials and methods: We evaluated 844 CT scanning records from 893 patients undergoing CEA from 1986-1994: 43% (367) CT positive for cerebral infarction and 57% (477) negative. Univariate and multivariat e analysis was performed for risk factors and preoperative symptoms in patients with positive and negative CT scans, and Kaplan Meier surviv al curves for late events. Results: A positive CT was significantly mo re frequent in males vs. females (p < 0.0001; O.R. 2.52; C.I. 1.73-3.7 3), diabetics vs. non-diabetics (p = 0.03; O.R. 1.52; C.I. 1.03-2.26), symptomatics vs. asymptomatics (p < 0.001; O.R. 2; C.I. 1.93-3.53) an d contralateral occlusion vs. patency (p < 0.001; O.R. 2; C.I. 1.30-3. 10). The perioperative disabling stroke/death rate was higher in patie nts with a positive CT (p = 0.002; O.R. 6.27; C.I. 1.73-34.20); in asy mptomatic patients this difference was striking (5 patients vs. O, p = 0.0002). Multiple logistic regression analysis for risk factors, CT f indings, symptoms preceding surgery, and congruity of brain infarction confirmed a significantly higher incidence of perioperative stroke/de ath rate (p = 0.003; O.R. 6.37; C.I. 5.12-763) and early and late stro ke (p = 0.02; O.R. 1.95; C.I. 1.38-2.53) and death (p = 0.0005; O.R. 2 .38; C.I. 1.89-2.88) in patients with brain lesions. After 7 years, th e survival rate (p = 0.0009) and stroke-free interval (p = 0.003) were lower in patients with a positive CT. After 5 years, in asymptomatic patients the survival rate (p = 0.003) and stroke-free interval (p = 0 .01) were lower in the positive CT group. Conclusions: A positive CT f inding, regardless of congruity of the lesion, should be regarded as a n indicator of an increased risk of stroke and death in patients sched uled for carotid surgery, especially in those with asymptomatic stenos is.