Poor Neurological Deficit Was an Independent 30-day Risk Factor in Symptomatic Carotid Stenosis after CEA with Selective Shunting
| Autor: | Deqing Peng, Faliang Gao, Wenyan Zhao, Lin Lou, Xiao Jin, Cheng Wu, Weijun Sun |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors medicine.medical_treatment Myocardial Infarction Carotid endarterectomy 030204 cardiovascular system & hematology Risk Assessment 030218 nuclear medicine & medical imaging Coronary artery disease 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine medicine Humans Carotid Stenosis cardiovascular diseases Myocardial infarction Risk factor Stroke Aged Cerebral Hemorrhage Ischemic Stroke Retrospective Studies Aged 80 and over Neurologic Examination Endarterectomy Carotid business.industry General Medicine Odds ratio Perioperative Middle Aged medicine.disease Stenosis Treatment Outcome Cerebrovascular Circulation Cardiology Female Surgery Cardiology and Cardiovascular Medicine business |
| Zdroj: | Annals of Vascular Surgery. 73:351-360 |
| ISSN: | 0890-5096 |
| DOI: | 10.1016/j.avsg.2020.11.045 |
| Popis: | Carotid endarterectomy (CEA) prevents the occurrence of stroke in the future, although its efficacy depends on the detection and control of high perioperative risk factors. We aimed to analyze the association between preoperative neurological deficit and the 30-day risk of major adverse cardiovascular events (MACEs) in CEA with selective shunting for symptomatic carotid stenosis.We assessed 653 patients who underwent CEA with selective shunting for symptomatic carotid stenosis between August 2011 and August 2019. The primary outcomes of the study were the occurrence of MACEs, defined as stroke (ischemic stroke or cerebral hemorrhage), all-cause mortality, and myocardial infarction during the perioperative period after CEA. Baseline patient characteristics were analyzed to identify factors associated with perioperative (30 days) MACEs. Multivariable logistic regression models were used to estimate the association between preoperative modified Rankin Scale (mRS) and the 30-day risk of MACEs. Interaction and stratified analyses were conducted according to age, drinking, history of hypertension and coronary artery disease, and surgical side.The mean age of patients was 68.7 ± 9.1 years, and 86.4% were men. The 30-day MACEs rate was 2.5%. In univariate logistic regression, histories of coronary artery disease (odds ratio (OR), 2.57 [95% confidence interval (CI), 1.04-6.34]), a severe contralateral carotid stenosis or occlusion (OR, 4.52 [95% CI, 1.84-11.11]), and a poor neurological deficit (mRS ≥ 3 versus mRS3: OR, 3.78 [95% CI, 1.21-11.82]) were associated with higher primary outcome rates. A history of hypertension did not increase the risk of MACEs (OR, 0.37 [95% CI, 0.15-0.89]). In the multivariable regression analysis, poor neurological deficit was associated with a higher risk of the MACEs within 30 days (mRS ≥ 3 versus mRS3: 11.1% vs. 2.0%, adjusted OR 5.70 [95% CI, 1.50-21.60]). The interaction analysis revealed no interactive role in the association between neurological deficit and 30-day risk of MACEs.Poor neurological deficit was an independent risk factor associated with the 30-day risk of MACEs in symptomatic patients who underwent CEA with selective shunting. Our findings may provide guidance to surgeons when treating patients with poor neurological deficit. The decision to perform surgery should be made after careful consideration. |
| Databáze: | OpenAIRE |
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