Prospective study on the complication rate of carotid surgery.
BACKGROUND
Randomized trials of carotid endarterectomy for high-grade stenosis have shown a benefit for surgery under the condition of low perioperative complication rates. Concerns have been expressed that the complication rates of carotid surgery are higher in everyday practice and may vary considerably between centers. We prospectively established the complication rate for carotid surgery in a single institution.


METHODS
Prospective 2-year study. All patients received pre- and postoperative neurological evaluation. Laboratory tests included pre- and postoperative brain imaging, intracranial and neck vessel sonography, conventional angiography, magnetic resonance angiography, and intraoperative monitoring.


METHODS
108 consecutive patients: 54 symptomatic patients fulfilling the inclusion criteria of the European Carotid Surgery Trial (ECST) and 54 asymptomatic patients fulfilling the inclusion criteria of the North American Trial on Asymptomatic Stenoses (ACAS).


METHODS
Single academic center with a high volume of carotid endarterectomies (>50 per year). Participating center in ECST.


METHODS
Stroke or death as defined in the randomized trials.


RESULTS
The overall complication rate was 8.3% (95% CI 4.1-15.6%). Complications were more frequent in patients with symptomatic stenosis (11.1%, CI 4.6-23.3%) than in asymptomatic cases (5.6%, CI 1.5-16.4%). Three patients died (2 strokes, 1 myocardial infarction). Disabling strokes were found in 2 patients (Rankin scale scores 3 and 4). Nondisabling strokes (Rankin scale score 1 and 2) occurred in 4 patients. The complication rates for symptomatic and asymptomatic patients were higher than the ones reported in the randomized trials, but 95% confidence intervals showed that the differences were not statistically significant. The point estimates of complication rates still supported a benefit of surgery for patients with symptomatic stenosis, but denied a positive effect of endarterectomy for patients with asymptomatic stenosis.


CONCLUSIONS
In this center, a beneficial effect of carotid surgery for asymptomatic stenoses cannot be safely assumed.
Hartmann
A
A
Stroke Unit, Neurologische Klinik und Chirurgische Klinik, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin, Germany. ahart@zedat.fu-berlin.de
Hupp
T
T
Koch
H C
HC
Dollinger
P
P
Stapf
C
C
Schmidt
R
R
Hofmeister
C
C
Thompson
J L
JL
Marx
P
P
Mast
H
H
D000328:Adult; D017677:Age Distribution; D000368:Aged; D016893:Carotid Stenosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology