Medical complications associated with carotid endarterectomy. North American Symptomatic Carotid Endarterectomy Trial (NASCET)
OBJECTIVE
Carotid endarterectomy (CE) has been shown to be beneficial in patients with symptomatic high-grade (70% to 99%) internal carotid artery stenosis. To achieve this benefit, complications must be kept to a minimum. Complications not associated with the procedure itself, but related to medical conditions, have received little attention.


METHODS
Medical complications that occurred within 30 days after CE were recorded in 1415 patients with symptomatic stenosis (30% to 99%) of the internal carotid artery. They were compared with 1433 patients who received medical care alone. All patients were in the North American Symptomatic Carotid Endarterectomy Trial (NASCET).


RESULTS
One hundred fifteen patients (8.1%) had 142 medical complications: 14 (1%) myocardial infarctions, 101 (7.1%) other cardiovascular disorders, 11 (0.8%) respiratory complications, 6 (0.4%) transient confusions, and 10 (0.7%) other complications. Of the 142 complications, 69.7% were of short duration, and only 26.8% prolonged hospitalization. Five patients died: 3 from myocardial infarction and 2 suddenly. Medically treated patients experienced similar complications with one third the frequency. Endarterectomy was approximately 1.5 times more likely to trigger medical complications in patients with a history of myocardial infarction, angina, or hypertension (P<0.05).


CONCLUSIONS
Perioperative medical complications were observed in slightly fewer than 1 of every 10 patients who underwent CE. The majority of these complications completely resolved. Most complications were cardiovascular and occurred in patients with 1 or more cardiovascular risk factors. In this selected population, the occurrence of perioperative myocardial infarction was uncommon.
Paciaroni
M
M
John P. Robarts Research Institute, University of Western Ontario, London, Ontario, Canada.
Eliasziw
M
M
Kappelle
L J
LJ
Finan
J W
JW
Ferguson
G G
GG
Barnett
H J
HJ
D000368:Aged; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000209:etiology; D002343:Carotid Artery, Internal / Q000601:surgery*; D016893:Carotid Stenosis / Q000188:drug therapy / Q000601:surgery; D003221:Confusion / Q000209:etiology; D004691:Endarterectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced / Q000209:etiology / Q000401:mortality; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012120:Respiration Disorders / Q000139:chemically induced / Q000209:etiology; D012307:Risk Factors