title: Carotid artery surgery: high-risk patients or high-risk centers?
abstract: BACKGROUND
  Carotid angioplasty and stenting has been proposed as an alternative to carotid endarterectomy (CEA) in patients deemed as at high risk for this surgical procedure. To date, definitely accepted criteria to identify "high-risk" patients for CEA do not exist. Our objective was to assess the relevance of numerous supposed high-risk factors in our experience, as well as their possible effect on our early postoperative results.
  
  
  METHODS
  A retrospective review of 1,033 consecutive CEAs performed during a 5.6-year period at a single institution was conducted (Vascular Surgery Department, St. Etienne University Hospital, France). Early results in terms of mortality and neurologic events were recorded. Univariate and multivariate analyses for early risk of stroke, myocardial infarction, and death were performed, considering the influence of age, sex, comorbidities, clinical symptoms, and anatomic features.
  
  
  RESULTS
  The cumulative 30-day stroke and death rate was 1.2%. A total of 10 strokes occurred and resulted in three deaths. The postoperative stroke risk was significantly higher in the subgroup of patients treated for symptomatic carotid artery disease: 2,6% (P = 0,004). Univariate analysis and logistic regression did not show statistical significance for 30-day results in any of the considered variables.
  
  
  CONCLUSIONS
  Patients with significant medical comorbidities, contralateral carotid occlusion, and high carotid lesions can undergo surgery without increased complications. Those parameters should not be used as exclusion criteria for CEA.
authors.affiliation: Department of vascular surgery, St Etienne University Hospital, St Etienne, France. zakibouzi@yahoo.fr
authors.forename: Zakariyae
authors.initials: Z
authors.lastname: Bouziane
authors.forename: Ghislain
authors.initials: G
authors.lastname: Nourissat
authors.forename: Ambroise
authors.initials: A
authors.lastname: Duprey
authors.forename: Jean Noel
authors.initials: JN
authors.lastname: Albertini
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Favre
authors.forename: Xavier
authors.initials: X
authors.lastname: Barral
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002343:Carotid Artery, Internal / Q000601:surgery*; D016893:Carotid Stenosis / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D005602:France; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome