title: Impact of diabetes mellitus on characteristics of carotid plaques and outcomes after carotid endarterectomy.
abstract: BACKGROUND
  Published results for carotid endarterectomy (CEA) in symptomatic and asymptomatic severe carotid stenosis with diabetes mellitus (DM) are contradictory. To evaluate perioperative and long-term results of CEA in patients with DM, we retrospectively analyzed data of patients with or without DM who underwent CEA in our institute.
  
  
  METHODS
  Between January 2005 and December 2010, 281 consecutive CEAs were performed in 268 patients under general anesthesia. All patients were subject to cardiac work-ups before surgery, and coronary revascularization was performed prior to CEA if patients were diagnosed with significant coronary artery stenosis. Lesion characteristics were assessed by a duplex ultrasound scan, computed tomography angiography (CTA), and plaque imaging on magnetic resonance imaging (MRI) before surgery, and patients were followed-up by a duplex ultrasound scan at three, six, and 12 months, then yearly, after surgery.
  
  
  RESULTS
  Of 281 cases, 136 had DM (48 %). Diabetic patients more frequently had a history of coronary artery disease than non-diabetic patients (48.5 % vs. 36.6 %, P = 0.042). Coronary intervention prior to CEA was more frequently performed in diabetic patients than in non-diabetic patients (22.1 % vs. 11.0 %, P = 0.013). The incidence of perioperative (30 day) stroke (P = 1.000), death (P = 1.000), and cardiac complications (P = 0.484) did not differ among groups. Follow-up was available in 77.2 % of patients, with a median duration of 50 months (interquartile range, 32.1-67.2 months). The incidence of ipsilateral stroke (P = 0.720), death (P = 0.351), and severe restenosis (peak systolic velocity > 230 cm/sec) (P = 0.905) were not different between groups.
  
  
  CONCLUSIONS
  DM does not increase the risk of perioperative complications and does not influence long-term outcomes after CEA if preexisting vascular risk factors and cardiac diseases are appropriately evaluated and treated before surgery.
authors.affiliation: Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Satomi
authors.initials: S
authors.lastname: Mizuhashi
authors.forename: Hiroharu
authors.initials: H
authors.lastname: Kataoka
authors.forename: Noritaka
authors.initials: N
authors.lastname: Sano
authors.forename: Minoru
authors.initials: M
authors.lastname: Ideguchi
authors.forename: Masahiro
authors.initials: M
authors.lastname: Higashi
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Miyamoto
authors.forename: Koji
authors.initials: K
authors.lastname: Iihara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D016022:Case-Control Studies; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000601:surgery; D003920:Diabetes Mellitus / Q000453:epidemiology*; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex