A. Hoffmann et al., THE INFLUENCE OF THE STATE OF THE VERTEBRAL ARTERIES ON THE PERI-OPERATIVE AND POSTOPERATIVE RISK IN CAROTID SURGERY, European journal of vascular and endovascular surgery, 16(4), 1998, pp. 329-333
Objectives: to assess the significance of the vertebral arteries (VA)
ns a prognostic factor within the framework of carotid surgery. Design
: prospective observational study. Materials: a total of 1338 operatio
ns were performed on 1182 patients. Three hundred and six of the patie
nts had angiographically confirmed unilateral (299) or bilateral (seve
n) involvement of the VA. In 31 cases it was not possible to assess th
e VA. Methods: life table analysis. Results: thirty-day mortality rate
was 1.6% (21 out of 1338) for all reconstructions of the internal car
otid artery. In addition to three fatal strokes, 22 hemispheric events
were noted (1.6%, 22/1338). Follow-up varied between 1 and 96 months
(mean 34, S.E.M. 0.76, median 29) and covered a total of 3361 patient
years. The cumulative 5-year survival rate was 69%. Irrespective of ag
e, cardiac events were the lending cause of death. In patients with VA
involvement, both the 30-day stroke and mortality rate (p<0.01) and t
he long-term survival rate (p<0.01) were significantly poorer. Conclus
ion: concomitant vertebral artery disease increases the morbidity and
mortality of carotid surgery, presumably due to reduced collateral per
fusion during cross-clamping. However, the overall risk of surgery rem
ains acceptable.