title: Risk Factors For Stroke, Myocardial Infarction, or Death Following Carotid Endarterectomy: Results From the International Carotid Stenting Study.
abstract: OBJECTIVE
  Carotid endarterectomy (CEA) is standard treatment for symptomatic carotid artery stenosis but carries a risk of stroke, myocardial infarction (MI), or death. This study investigated risk factors for these procedural complications occurring within 30 days of endarterectomy in the International Carotid Stenting Study (ICSS).
  
  
  METHODS
  Patients with recently symptomatic carotid stenosis >50% were randomly allocated to endarterectomy or stenting. Analysis is reported of patients in ICSS assigned to endarterectomy and limited to those in whom CEA was initiated. The occurrence of stroke, MI, or death within 30 days of the procedure was reported by investigators and adjudicated. Demographic and technical risk factors for these complications were analysed sequentially in a binomial regression analysis and subsequently in a multivariable model.
  
  
  RESULTS
  Eight-hundred and twenty-one patients were included in the analysis. The risk of stroke, MI, or death within 30 days of CEA was 4.0%. The risk was higher in female patients (risk ratio [RR] 1.98, 95% CI 1.02-3.87, p = .05) and with increasing baseline diastolic blood pressure (dBP) (RR 1.30 per +10 mmHg, 95% CI 1.02-1.66, p = .04). Mean baseline dBP, obtained at the time of randomization in the trial, was 78 mmHg (SD 13 mmHg). In a multivariable model, only dBP remained a significant predictor. The risk was not related to the type of surgical reconstruction, anaesthetic technique, or perioperative medication regimen. Patients undergoing CEA stayed a median of 4 days before discharge, and 21.2% of events occurred on or after the day of discharge.
  
  
  CONCLUSIONS
  Increasing diastolic blood pressure was the only independent risk factor for stroke, MI, or death following CEA. Cautious attention to blood pressure control following symptoms attributable to carotid stenosis could reduce the risks associated with subsequent CEA.
authors.affiliation: Institute of Neurology, University College London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Doig
authors.affiliation: Department of Biostatistics and Bioinformatics and Duke Global Health Institute, Duke University, Durham, NC, USA.
authors.forename: E L
authors.initials: EL
authors.lastname: Turner
authors.affiliation: Department of Medical Statistics, London School of Hygiene and Tropical Medicine, UK.
authors.forename: J
authors.initials: J
authors.lastname: Dobson
authors.affiliation: Institute of Neurology, University College London, UK.
authors.forename: R L
authors.initials: RL
authors.lastname: Featherstone
authors.affiliation: Department of Vascular Surgery, University Medical Centre Utrecht, The Netherlands.
authors.forename: G J
authors.initials: GJ
authors.lastname: de Borst
authors.affiliation: Department of Vascular Surgery, Freeman Hospital, Newcastle upon Tyne, UK.
authors.forename: G
authors.initials: G
authors.lastname: Stansby
authors.affiliation: Sheffield Vascular Institute, Northern General Hospital, Sheffield, UK.
authors.forename: J D
authors.initials: JD
authors.lastname: Beard
authors.affiliation: Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland.
authors.forename: S T
authors.initials: ST
authors.lastname: Engelter
authors.affiliation: Division of Surgery and Interventional Science, University College London, UK.
authors.forename: T
authors.initials: T
authors.lastname: Richards
authors.affiliation: Institute of Neurology, University College London, UK. Electronic address: martin.brown@ucl.ac.uk.
authors.forename: M M
authors.initials: MM
authors.lastname: Brown
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000295:instrumentation*; D001794:Blood Pressure; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D016017:Odds Ratio; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D020521:Stroke / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome
keywords: Carotid artery stenosis; Carotid atherosclerosis; Carotid endarterectomy