Risk factors for peri-operative stroke complicating carotid endarterectomy: selective analysis of a prospective audit of 1000 consecutive operations.
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.
Frawley
J E
JE
Department of Vascular and Transplantation Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia.
Hicks
R G
RG
Woodforth
I J
IJ
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
D018686:Anesthetics, Intravenous; D013874:Thiopental