title: Influence of chronic renal insufficiency on outcomes following carotid revascularization.
abstract: OBJECTIVE
  To examine the perioperative and long-term outcomes of patients undergoing carotid revascularization and to determine the influence moderate or severe renal insufficiency may have on these outcomes.
  
  
  METHODS
  Retrospective database review.
  
  
  METHODS
  Academic tertiary hospital.
  
  
  METHODS
  Patients undergoing carotid endarterectomy and carotid angioplasty and stenting from 1996 to 2006.
  
  
  METHODS
  Carotid revascularization.
  
  
  METHODS
  Glomerular filtration rate (GFR) was calculated based on the Modification of Diet in Renal Disease equation. Groups were analyzed by stages 0 to 2 (GFR ≥60 mL/min/1.73m(2)) vs stage 3 (GFR <60 and ≥30 mL/min/1.73m(2)) vs stages 4 and 5 (GFR <30 mL/min/1.73m(2)).
  
  
  RESULTS
  Nine hundred twenty-one carotid interventions were performed (750 carotid endarterectomy, 171 carotid angioplasty and stenting). The overall 30-day mortality and morbidity rates were 1.1% and 16.9%, respectively. Sixty-six percent of patients had normal renal function (stages 0-2). Twenty-eight percent of patients had moderate renal insufficiency (stage 3) and 6% of patients had severe renal insufficiency (stages 4-5). The 30-day stroke rates for groups were 2.98% (normal renal function), 2.67% (moderate renal insufficiency), and 5.45% (severe renal insufficiency) (P = .54). Thirty-day mortality rates between groups were 0.66% (normal renal function), 1.15% (moderate renal insufficiency), and 5.45% (severe renal insufficiency) (P = .005). For carotid endarterectomy, no difference in freedom from stroke existed based on level of renal function. For carotid angioplasty and stenting, patients with severe renal insufficiency exhibited significantly lower rates of freedom from stroke.
  
  
  CONCLUSIONS
  Chronic kidney disease is prevalent among patients undergoing carotid revascularization. Overall, patients with moderate renal function have similar outcomes. However, those with severe renal insufficiency have significantly higher 30-day mortality when undergoing carotid revascularization.
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Clinton D
authors.initials: CD
authors.lastname: Protack
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Bakken
authors.forename: Wael E
authors.initials: WE
authors.lastname: Saad
authors.forename: Mark G
authors.initials: MG
authors.lastname: Davies
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D016893:Carotid Stenosis / Q000150:complications* / Q000628:therapy*; D016894:Endarterectomy, Carotid; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome