Is diabetes mellitus a risk factor for carotid endarterectomy? A prospective study

Background. Although many randomized trials and other multicenter studies h ave demonstrated the benefits of carotid endarterectomy (CEA) in selected s ymptomatic and asymptomatic patients, several investigators have noted an i ncreased rate of perioperative neurologic and cardiac morbidity in diabetic patients. To compare the perioperative outcome of CEA in diabetic patients (group I) versus nondiabetic patients (group II), we analyzed a consecutiv e series of CEAs per formed by the same vascular surgeons at the same insti tution. Methods. Data collection was prospective for all CEA procedures performed b etween August 1, 1992 and March 31, 1999. Group I and group II were matched for clinical presentation, percentage of internal carotid artery stenosis and indication for surgery. Results. Of 547 CEAs performed in 474 patients, 199 (36.4%) were in group I . Group I was younger at presentation than group II (P<.005) and women were in a higher proportion in group I than in group II (43.7% vs 27.1%, P = .0 001). Although the incidence of peripheral atherosclerotic disease was comp arable in the 2 groups, there was a significantly higher incidence of previ ous vascular surgery in group I (P=.01). Perioperative neurologic and cardi ac morbidity rates were comparable in the 2 groups. The overall perioperati ve mortality rate was 0.5%. Long-term information was obtained in all patie nts (mean, 44 months; range, 1 to 75 months). No differences were found in the recurrent stenosis and occlusion rates between the 2 groups. Although t here was no difference in the late mortality between the 2 groups, diabetic patients had a significantly higher cardiac-related death incidence (P=.01 ) than nondiabetic patients. Conclusions. The findings of this analysis indicate that CEA can be per for med in diabetic patients with excellent perioperative morbidity and mortali ty rates and late stroke-free and survival rats that are comparable with th ose recorded in nondiabetic patients.