Computerised tomography findings as a risk factor in carotid endarterectomy: Early and late results

Autor: P. De Rango, L. Moggi, Basso Parente, Giuseppe Giordano, Piergiorgio Cao, Fabio Verzini, G. Carlini
Rok vydání: 1996
Předmět:
Male
medicine.medical_treatment
Carotid endarterectomy
ACUTE CEREBROVASCULAR-DISEASE
Risk Factors
Cause of Death
Medicine
Carotid Stenosis
brain infarction
computed tomography
carotid endarterectomy SILENT CEREBRAL INFARCTION
TRANSIENT ISCHEMIC ATTACK
STROKE-PROJECT 1981-86
PLAQUE ULCERATION
1ST-EVER STROKE
COMMUNITY
ARTERY
CT
PREVALENCE
Computed tomography
Stroke
Cause of death
Aged
80 and over
Medicine(all)
Endarterectomy
Carotid
Cerebral infarction
Mortality rate
Cerebral Infarction
Middle Aged
Survival Rate
Female
Radiology
medicine.symptom
Cardiology and Cardiovascular Medicine
Brain infarction
Adult
medicine.medical_specialty
Asymptomatic
Disease-Free Survival
Diabetes Complications
Sex Factors
Preoperative Care
Humans
Risk factor
Survival rate
Vascular Patency
Aged
Retrospective Studies
business.industry
medicine.disease
Cerebrovascular Disorders
Logistic Models
Multivariate Analysis
Surgery
Tomography
X-Ray Computed
business
Zdroj: European Journal of Vascular and Endovascular Surgery. 12:37-45
ISSN: 1078-5884
DOI: 10.1016/s1078-5884(96)80273-5
Popis: Objectives:To evaluate whether preoperative CT evidence of brain infarction is associated with an increased risk of early and late stroke and death in patients undergoing CEA.Design:Retrospective clinical study.Materials and methods:We evaluated 844 CT scanning records from 893 patients undergoing CEA from 1986–1994: 43% (367) CT positive for cerebral infarction and 57% (477) negative. Univariate and multivariate analysis was performed for risk factors and preoperative symptoms in patients with positive and negative CT scans, and Kaplan Meier survival curves for late events.Results:A positive CT was significantly more frequent in males vs. females (p < 0.0001; O.R. 2.52; C.I. 1.73–3.73), diabetics vs. non-diabetics (p = 0.03; O.R. 1.52; C.I. 1.03–2.26), symptomatics vs. asymptomatics (p < 0.001; O.R. 2; C.I. 1.93–3.53) and contralateral occlusion vs. patency (p < 0.001; O.R. 2; C.I. 1.30–3.10). The perioperative disabling stroke/death rate was higher in patients with a positive CT (p = 0.002; O.R. 6.27; C.I. 1.73–34.20); in asymptomatic patients this difference was striking (5 patients vs. 0, p = 0.0002). Multiple logistic regression analysis for risk factors, CT findings, symptoms preceding surgery, and congruity of brain infarction confirmed a significantly higher incidence of perioperative stroke/death rate (p = 0.003; O.R. 6.37; C.I. 5.12–7.63) and early and late stroke (p = 0.02; O.R. 1.95; C.I. 1.38–2.53) and death (p = 0.0005; O.R. 2.38; C.I. 1.89–2.88) in patients with brain lesions. After 7 years, the survival rate (p = 0.0009) and stroke-free interval (p = 0.003) were lower in patients with a positive CT. After 5 years, in asymptomatic patients the survival rate (p = 0.003) and stroke-free interval (p = 0.01) were lower in the positive CT group.Conclusions:A positive CT finding, regardless of congruity of the lesion, should be regarded as an indicator of an increased risk of stroke and death in patients scheduled for carotid surgery, especially in those with asymptomatic stenosis.
Databáze: OpenAIRE
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