title: Successful management of carotid stenosis in a high-risk population at an inner-city hospital.
abstract: This is a retrospective review of all carotid endarterectomies (CEA) (n=91) done from 1993 to 2002 at an inner-city hospital (Group I). This group was compared to a randomly selected group of patients (n=445) treated at a private hospital (Group II). The same high-volume surgeons performed CEAs at both hospitals. The majority of Group I patients (71.4%) were members of racial minority groups. They were also more likely to be younger (p<0.001), hypertensive (p<0.03), diabetic (p<0.001), and current smokers (p<0.001); have contralateral carotid artery occlusion (p=0.04); and present with stroke (p<0.001) than Group II patients. Despite this, the incidence of postoperative myocardial infarction (2.2% vs 0.2%, p=0.08), stroke (1.1% vs 1.6%, NS), and death (1.1% vs 0%, NS) was comparable between the 2 groups. Aggressive preoperative workup for occult cardiac disease in Group I revealed an incidence of 25.9% (n=15). Of these, 5 (33.3%) were found to have coronary artery disease severe enough to warrant intervention before CEA. In an inner-city population with increased medical comorbidities, more severe cerebrovascular disease, and relatively low volume of carotid surgery, the results of CEA were comparable to those in patients treated at a high-volume private hospital. The presence of high-volume surgeons, operating at the low-volume municipal hospital, may contribute to the low complication rate. Finally, aggressive preoperative cardiac workup in this underserved population revealed a meaningful incidence of occult coronary artery disease requiring intervention before CEA.
authors.affiliation: Division of Vascular Surgery, New York University School of Medicine, New York, NY 10016, USA. thomas.maldonado@med.nyu.edu
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Maldonado
authors.forename: Ricardo
authors.initials: R
authors.lastname: Moreno
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Gagne
authors.forename: Mark A
authors.initials: MA
authors.lastname: Adelman
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Nalbandian
authors.forename: Danielle
authors.initials: D
authors.lastname: Bajakian
authors.forename: Glenn R
authors.initials: GR
authors.lastname: Jacobowitz
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Lamparello
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Riles
authors.forename: Caron B
authors.initials: CB
authors.lastname: Rockman
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000453:epidemiology / Q000601:surgery*; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology; D016894:Endarterectomy, Carotid; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D016896:Treatment Outcome