The Assessment of Outcome in Carotid Artery Operations Performed in the Period 1997– 2009

Česká verzia

Authors: Z. Šilhart ¹; J. Hillová Mannová ²; P. Kysela ¹; I. Hamtilová ¹; J. Ničovský ¹; P. Ševčík ²; Z. Kala ¹
Authors place of work: LF MU a FN Brno Chirurgická klinika ¹; LF MU a FN Brno Klinika anesteziologie, resuscitace a intenzivní medicíny ²
Published in the journal: Cesk Slov Neurol N 2010; 73/106(3): 294-298
Category: Short Communication

Summary

Introduction:
Carotid endarterectomy is a frequently performed operation in the Department of Surgery (vascular surgery) of the Faculty Hospital, Brno. An audit of carotid artery operations was made covering the last 13 years and the results are presented in this article. Results: 1,957 patients underwent carotid artery operations in the years 1997– 2009. Carotid endarterectomy as a treatment for carotid occlusive disease was indicated in 96% (1,882) patients (symptomatic carotid stenosis 1,346 patients, asymptomatic 536). The traditional longitudinal arteriotomy was chosen as operating technique in 1,827 patients, with primary closures in 30% (546) and patch angioplasty in 70% (1,281). Patch types broke down into vein patches (1,110) and synthetic patches (171), while shunts were inserted in 1,179 patients. General anaesthesia was performed in 90% (1,762), cervical plexus block in 10% (195). The frequency of postoperative complications was: stroke, TIA 19 (1%); operation revision for bleeding 15 (0.8%); ACI thrombosis 8 (0.45%); nerve injuries 9 (0.5%); and carotid re‑stenosis 25 (1.3%). The 30- day mortality figure was 7 (0.35%). Conclusion: Carotid endarterectomy still remains a gold standard for the treatment of carotid occlusive disease. The benefits of the procedure depend on institutional outcomes. Giving preference to carotid artery operations in high‑volume centres with extensive experience and good results enables patients to undergo this operation with lower frequency of postoperative complications and mortality and may contribute to better quality of life after carotid endarterectomy.

Key words:
carotid stenosis – carotid endarterectomy – postoperative complications – mortality

Zdroje

1. Čertík B, Machart S, Novák M. Onemocnění karotid a velkých cév aortálního oblouku. 1st ed. Praha: Grada 2005.

2. Podlaha J. Chirurgie extrakraniálního karotického řečiště. 1st ed. Praha: Grada 2006.

3. Halliday A, Mansfield A, Marro J, Peto C, Peto R, Potter J et al. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: a randomized controlled trial. Lancet 2004; 363(9420): 1491– 1502.

4. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA 1995; 273(18): 1421– 1428.

5. European Carotid Surgery Trial Collaborators. Randomized trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet 1998; 351(9113): 1379– 1387.

6. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high‑grade carotid stenosis. N Engl J Med 1991; 325(7): 445– 453.

7. Chaer RA, Makaroun MS. Carotid artery stenosis: what is left to surgery. J Cardiovas Surg (Torino) 2009; 50(1): 39– 47.

8. Hobson RW jr, Howard VJ, Roubin GS, Brott TG Ferguson RD, Popma JJ at al. Carotid artery stenting is associated with increased complications in octogenarians: 30- day stroke and death rates in the CREST lead- in phase. J Vasc Surg 2004; 40(6): 1106– 1111.

9. Ouriel K, Hertzer NR., Beven EG, Ohara PJ, Krajewski LP, Clair DG et al. Preprocedural risk stratification: identifying an appropriate population for carotid stenting. J Vasc Surg 2001; 33(4): 728– 732.

10. Mas JL, Chatellier G, Beyssen B, Branchereau A, Moulin T, Becquermin JP et al. EVA- 3S Investigators. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med 2006; 355(16): 1660– 1671.

11. Ringleb PA, Allenberg J, Brückmann H, Eckstein HH, Fraedrich G, Hartmann M et al. 30 days results from the SPACE trial of stent‑ protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomized non‑inferiority trial. Lancet 2006; 368(9543): 1239– 1247.

12. Girn HRS, Dellagrammaticas D, Laughlan K, Gough MJ. Carotid Endarterectomy: Technical Practices of Surgeons Participating in the Gala Trial. Eur J Vasc Endovasc Surg 2008; 36(4): 385– 389.

13. Lewis SC, Warlow CP, Bodenham AR, Colam B, Rothwell PM, Torgerson D et al. General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicentre, randomised controlled trial. Lancet 2008; 372(9656): 2132– 2142.

14. Gumerlock MK, Neuwelt EA. Carotid endarterectomy: to shunt or not to shunt. Stroke 1988; 19(12): 1485– 1419.

15. Sandmann W, Kolvenbach R, Willeke F. Risk and benefit of shunting in carotid endarterectomy. Stroke 1993; 24(7): 1098– 1099.

16. Howell J. Carotid endarterectomy. Br J Anaesth 2007; 99(1): 119– 131.

17. McCarthy RJ, McCabe AE, Walker R, Horrocks M.The value of transcranial Doppler in predicting cerebral ischemia during carotid endarterectomy. Eur J Vasc Endovasc Surg 2001; 21(5): 408– 412.

18. Payne RS, Akca O, Roewer N, Schurr A, Kehl F. Sevoflurane‑induced preconditioning protects against cerebral ischemic neuronal damage in rats. Brain Res 2005; 1034(1– 2): 147– 152.

19. Guay J. Regional anesthesia for carotid surgery. Curr Opin Anaesthesiol 2008; 21(5): 638– 644.

20. Kim LJ, Martinez EA, Faraday N, Dorman T, Fleisher LA, Perler BA et al. Cardiac troponin I predicts short‑term mortality in vascular surgery patients. Circulation 2002; 106(18): 2366– 2371.

21. Landesberg G, Shatz V, Akopnik I, Wolf YG, Mayer M, Berlatzky Y et al. Association of cardiac troponin, CK‑ MB, and postoperative myocardial ischemia with long‑term survival after major vascular surgery. J Am Coll Cardiol 2003; 42(9): 1547– 1554.

22. Van der Heyden J, Suttorp MJ, Schepens M. Revascularization strategy in patients with severe concurrent severe carotid and coronary artery disease: “failure to move forward is mason to regress”. J Cardiovasc Surg 2009; 50(1): 55– 62.

23. Rothwell PM. Endarterectomy for Symptomatic and Asymptomatic Carotid Stenosis. Neurol Clin 2008; 26(4): 1079– 1097.

24. Hakl M, Michalek P, Ševčík P, Pavlíková J, Stern M. Regional anaesthesia for carotid endarterectomy: an audit over 10 years. Br J Anaesth 2007; 99(9): 415– 420.