Etiology of late cerebrovascular events after carotid endarterectomy.
BACKGROUND
Progressive carotid artery disease has been shown to cause cerebrovascular events years after a patient's carotid thromboendarterectomy (CEA). Yet, some late cerebrovascular events in CEA patients are attributable to other etiologies.


OBJECTIVE
We sought to determine frequency and characteristics of late cerebrovascular events in post-CEA patients attributable to etiologies other than progressive carotid disease.


METHODS
In a post hoc analysis of data from a CEA-registry with long-term follow-up, all patients with transient ischaemic attack (TIA) or stroke occurring >1 month post-CEA were identified. The etiologies of these events were dichotomized into the groups large-artery atherosclerosis (LAA) and that non-large-artery atherosclerosis (non-LAA), i.e. all other etiologies (Trial of Org 10172 in Acute Stroke Trial-criteria). Frequency and characteristics of both groups were compared.


RESULTS
Sixty of 361 post-CEA patients (16.6%; 95%CI 12.9-20.9%) had late cerebrovascular events after 7 years (median). Thirty patients had ischaemic strokes and 30 had TIAs. These events were attributable to LAA in 48% (29/60) and to non-LAA in 52% (31/60). In the LAA group, contralateral carotid stenosis (62%; 18/29) was more frequent than recurrent ipsilateral stenosis (38%; 11/29). Amongst non-LAA patients, cardioembolism (29%; 9/31) and small-artery-occlusion (23%; 7/31) were the most frequent causes. LAA and non-LAA patients did not differ in age, time since CEA, risk factor profile, type of event, and baseline medication.


CONCLUSIONS
In post-CEA-patients, half of the late cerebrovascular events were attributable to etiologies other than LAA. Clinical features did not distinguish LAA-events from non-LAA events. Thus, stroke prevention in post-CEA patients should not be confined to screening for progressive carotid disease but includes efforts to optimize the management of risk factor and cardiac diseases.
Fluri
F
F
Neurological Clinic and Stroke Unit, University Hospital Basel, Petersgraben 4, Basel, Switzerland.
Hatz
F
F
Neurological Clinic and Stroke Unit, University Hospital Basel, Petersgraben 4, Basel, Switzerland.
Voss
B
B
Neurological Clinic and Stroke Unit, University Hospital Basel, Petersgraben 4, Basel, Switzerland.
Lyrer
P A
PA
Neurological Clinic and Stroke Unit, University Hospital Basel, Petersgraben 4, Basel, Switzerland.
Engelter
S T
ST
Neurological Clinic and Stroke Unit, University Hospital Basel, Petersgraben 4, Basel, Switzerland.
D000368:Aged; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000453:epidemiology; D050197:Atherosclerosis / Q000150:complications; D016893:Carotid Stenosis / Q000150:complications / Q000453:epidemiology; D004617:Embolism / Q000150:complications / Q000453:epidemiology; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005260:Female; D007839:Functional Laterality; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*