title: Risk factors for peri-operative stroke complicating carotid endarterectomy: selective analysis of a prospective audit of 1000 consecutive operations.
abstract: BACKGROUND
  The aim of the present study was to investigate the role of potential clinical risk factors in the causation of peri-operative stroke associated with carotid endarterectomy. With the change in carotid endarterectomy practice from the use of a shunt to high-dose thiopental for cerebral protection (a previously undocumented method), it was essential to identify accurately the causes of all perioperative strokes.
  
  
  METHODS
  A prospective audit was undertaken of 1000 carotid endarterectomies in which the causes and pathology of all peri-operative strokes were documented. The roles of advanced age, female gender, hypertension, previous stroke, contralateral carotid stenosis >70%, and contralateral carotid occlusion as potential causes of peri-operative stroke were defined. Results were statistically analysed using odds ratio and Fisher's exact test.
  
  
  RESULTS
  None of the potential risk factors was statistically significant for peri-operative stroke. Female gender was associated with a significant risk of peri-operative stroke due to operative site thrombosis. Complications at the endarterectomy site were the commonest cause of stroke.
  
  
  CONCLUSIONS
  Prospective audit is a useful tool for identifying causes of peri-operative stroke and indicating the need for modifications to surgical clinical management which might improve outcomes for carotid endarterectomy.
authors.affiliation: Department of Vascular and Transplantation Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia.
authors.forename: J E
authors.initials: JE
authors.lastname: Frawley
authors.forename: R G
authors.initials: RG
authors.lastname: Hicks
authors.forename: I J
authors.initials: IJ
authors.lastname: Woodforth
mesh_terms: D000367:Age Factors; D000368:Aged; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D016893:Carotid Stenosis / Q000601:surgery; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008485:Medical Audit; D011184:Postoperative Period; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*; D013874:Thiopental / Q000008:administration & dosage
chemical_list: D018686:Anesthetics, Intravenous; D013874:Thiopental