title: Patients at elevated risk of major adverse events following endarterectomy for asymptomatic carotid stenosis.
abstract: BACKGROUND
  Carotid endarterectomy (CEA) as treatment in patients with asymptomatic carotid stenosis is the subject of much debate.
  
  
  METHODS
  The National Surgical Quality Improvement Program database from 2005 to 2012 was queried. Patients undergoing CEA for asymptomatic carotid stenosis were identified. Preoperative risk factors and patient demographics were compared using chi-square analysis and logistic regression to determine their relation with stroke and death.
  
  
  RESULTS
  During an 8-year period, 24,211 CEAs performed for asymptomatic carotid stenosis were identified. Patients with dependent functional status (12.5%), recent myocardial infarction (6.3%), chronic heart failure (5.0%), hypoalbuminemia (4.8%), angina (4.1%), dialysis dependence (3.4%), steroid dependence (3.4%), chronic obstructive pulmonary disease (3.3%), and American Society of Anesthesiologists > 3 (3.2%) had a clinically significant increase in risk of stroke and death. Patients with none of the above risk factors had a stroke and death rate of 1.08%, which was significantly less than the overall stroke and death rate (P < .001).
  
  
  CONCLUSIONS
  A high-risk subset of patients undergoing CEA for asymptomatic carotid stenosis can be identified. If patient selection is optimized and perioperative morbidity and mortality are minimized, CEA will continue to play an important role in stroke prevention for those with significant asymptomatic carotid stenosis.
authors.affiliation: Department of Surgery, Keck School of Medicine, University of Southern California, Pasadena, CA 91105, USA.
authors.forename: Tiffany Y
authors.initials: TY
authors.lastname: Wu
authors.affiliation: Department of Surgery, Keck School of Medicine, University of Southern California, Pasadena, CA 91105, USA.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Akopian
authors.affiliation: Department of Surgery, Keck School of Medicine, University of Southern California, Pasadena, CA 91105, USA. Electronic address: skatz@med.usc.edu.
authors.forename: Steven G
authors.initials: SG
authors.lastname: Katz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases; D016893:Carotid Stenosis / Q000601:surgery*; D016208:Databases, Factual; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality; D016896:Treatment Outcome; D055815:Young Adult
keywords: Asymptomatic carotid stenosis; Carotid endarterectomy; Carotid stenosis; NSQIP