Diabetes and asymptomatic carotid stenosis: does diabetic disease influence the outcome of carotid endarterectomy? A 10-year single center experience.
BACKGROUND
Few studies have focused directly on carotid endarterectomy (CEA) in symptomatic and asymptomatic diabetic patients, reporting controversial outcome. We compared perioperative (30-day) and late outcomes in diabetic versus nondiabetic patients undergoing CEA for severe asymptomatic carotid disease.


METHODS
Over 10 years, data were prospectively collected for diabetic and nondiabetic patients undergoing CEA for asymptomatic severe carotid disease. All procedures were eversion CEA. All patients underwent concomitant neurologic follow-up and a duplex ultrasound scan at 1, 6, and 12 months, then yearly, after operation.


RESULTS
Of 391 CEAs performed on 374 patients, 112 (28.7%) were in diabetic patients. There were no perioperative deaths or strokes in either diabetic patients or nondiabetic patients. A significantly higher incidence of cardiac complications occurred in diabetic patients (P < .01). A complete follow-up (mean, 6.1 years) was obtained for 348 patients. No recurrent stenoses or late occlusions were diagnosed in diabetic or nondiabetic patients. At 10 years, the risk of death was up to 4.6 times higher in diabetic patients, with a significant prevalence of cardiac-related deaths (P < .01).


CONCLUSIONS
CEA can be performed with no perioperative stroke risk or mortality, for asymptomatic disease in both diabetic and nondiabetic patients. The absence of fatal strokes associated with a significantly higher risk of cardiac-related death in the long-term points to the need to improve prevention strategies for postoperative cardiac risk in diabetic patients.
Ballotta
Enzo
E
Vascular Surgery Section of the Geriatric Surgery Clinic, Department of Surgical and Gastroenterological Sciences, University of Padua, School of Medicine, Padova, Italy. enzo.ballotta@unipd.it
Manara
Renzo
R
Meneghetti
Giorgio
G
Ermani
Mario
M
Da Giau
Giuseppe
G
Baracchini
Claudio
C
D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery*; D048909:Diabetes Complications / Q000150:complications*; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D016896:Treatment Outcome