DIABETES-MELLITUS - A RISK FACTOR FOR CAROTID ENDARTERECTOMY

Purpose: Symptomatic cerebrovascular disease is more common in patient s who have diabetes mellitus than in the nondiabetic population, even when matched for associated risk factors. Although the safety and effi cacy of carotid endarterectomy has been established by NASCET and ACAS , several small studies have noted an increased rate of perioperative neurologic morbidity in patients with diabetes. Methods: Data for all patients who underwent carotid endarterectomy at a single institution from Jan. 1990 to Dec. 1995 were prospectively entered into a computer ized vascular registry and form the basis of this report. Results: Of 732 carotid endarterectomy procedures performed, 284 (39%) were perfor med in patients who had diabetes mellitus. Patients with diabetes and without diabetes mere matched for clinical presentation (diabetic pati ents, 45% asymptomatic; nondiabetic patients, 43%) and internal caroti d artery percent stenosis (86.6% +/- 10.6% vs 86.4% +/- 10.6%). Patien ts with diabetes were younger at presentation than patients without (6 8.8 +/- 8.5 years vs 70.9 +/- 8.5 years; p < 0.005) and a ere more lik ely to have a history of coronary artery disease (53% vs 45%; p = 0.04 ). The mean total length of stay was 6.1 days for patients with diabet es and 4.8 days among patients without (P = 0.01). An adverse postoper ative cardiac event (myocardial infarction, congestive heart failure, or arrhythmia) occurred in nine patients with diabetes (3.2%) and in f ive nondiabetic patients (1.1%; p < 0.05). By logistic regression anal ysis, however, diabetes was not an independent risk factor for a posto perative cardiac event (P = 0.28). There ri cre 11 perioperative neuro logic events (eight cerebrovascular accidents, three transient ischemi c attacks) during the entire period (1.5%), of which six were among di abetic patients (2.1%) and five among nondiabetic patients (1.1%; p = NS). Of the eight cerebrovascular accidents, three occurred in diabeti c patients (1.0%) and five in nondiabetic patients (1.1%; p = NS). The total operative mortality rate was 0.3% (diabetic patients, 1 of 284, 0.35% nondiabetic, 1 of 447, 0.2%). Conclusions: Patients with diabet es who undergo carotid endarterectomy are more likely to have coexisti ng cardiac disease, which may contribute to a higher incidence of post operative cardiac morbidity. Diabetes mellitus alone, however, is not a risk factor for postoperative cardiac morbidity in patients who unde rgo carotid surgery. In addition, carotid endarterectomy may be safely performed in patients with diabetes with neurologic morbidity and mor tality rates that are comparable with those of the nondiabetic populat ion.