Medical complications associated with carotid endarterectomy

Background and Purpose-Carotid endarterectomy (CE) has been shown to be ben eficial in patients with symptomatic high-grade (70% to 99%) internal carot id artery stenosis. To achieve this benefit, complications must be kept to a minimum. Complications not associated with the procedure itself, but rela ted to medical conditions, have received little attention. Methods-Medical complications that occurred within 30 days after CE were re corded in 1415 patients with symptomatic stenosis (30% to 99%) of the inter nal carotid artery. They were compared with 1433 patients who received medi cal care alone. All patients were in the North American Symptomatic Carotid Endarterectomy Trial (NASCET). Results-One hundred fifteen patients (8.1%) had 142 medical complications: 14(1%) myocardial infarctions, 101 (7.1%) other cardiovascular disorders, 1 1 (0.8%) respiratory complications, 6 (0.4%) transient confusions, and 10 ( 0.7%) other complications. Of the 142 complications, 69.7% were of short du ration, and only 26.8% prolonged hospitalization. Five patients died: 3 fro m myocardial infarction acid 2 suddenly. Medically treated patients experie nced similar complications with one third the frequency. Endarterectomy was approximate to 1.5 times more likely to trigger medical complications in p atients with a history of myocardial infarction, angina, or hypertension (P <0.05). Conclusions-Perioperative medical complications were observed in slightly f ewer than 1 of every 10 patients who underwent CE. The majority of these co mplications completely resolved. Most complications were cardiovascular and occurred in patients with 1 or more cardiovascular risk factors. In this s elected population, the occurrence of perioperative myocardial infarction w as uncommon.