Asymptomatic carotid endarterectomy. Patient and surgeon selection.

Authors

Michael J. Marcinczyk MD, Lehigh Valley Health Network
Gary G. Nicholas MD, FACS, Lehigh Valley Health NetworkFollow
James F. Reed III, PhD, Lehigh Valley Health NetworkFollow
Susan A. Nastasee BSFollow

Publication/Presentation Date

2-1-1997

Abstract

BACKGROUND AND PURPOSE: The applicability of prospective carotid endarterectomy protocols to the general population has been questioned. Outcomes for asymptomatic patients undergoing carotid endarterectomy were compared with the results of the Asymptomatic Carotid Atherosclerosis Study (ACAS) patients treated concurrently at our institution.

METHODS: Asymptomatic patients undergoing carotid endarterectomies (n = 277) from 1987 to 1993 (ACAS enrollment period) were reviewed. Primary end points were mortality, myocardial infarction, and stroke. Five subgroups were studied: (1) ACAS surgical patients; (2) ACAS-eligible patients not enrolled and ACAS surgeons; (3) ACAS-eligible patients not enrolled and non-ACAS surgeons; (4) ACAS-ineligible patients and ACAS surgeons; and (5) ACAS-ineligible patients and non-ACAS surgeons.

RESULTS: ACAS-eligible patients were younger (P = .014), had more severe carotid stenosis (P = .001), and had lower incidences of pulmonary (P = .015) and renal (P = .008) diseases compared with ineligible patients. Patient selection (ACAS eligibility) significantly improved outcomes for mortality (P = .014) and myocardial infarction (P = .006). Length of stay favored ACAS-eligible patients (P = .004). ACAS surgeons operated on more severely stenotic carotid lesions (P = .005) and on patients with a lower incidence of coronary artery disease (P = .007). There was no difference in outcomes between ACAS and non-ACAS surgeons.

CONCLUSIONS: Patient selection was a significant factor in determining outcome. With strict adherence to ACAS enrollment guidelines, the conclusions of ACAS appear applicable to patients seen at our institution with asymptomatic carotid stenosis.

Volume

28

Issue

2

First Page

291

Last Page

296

ISSN

0039-2499

Published In/Presented At

Marcinczyk, M. J., Nicholas, G. G., Reed, J. 3., & Nastasee, S. A. (1997). Asymptomatic carotid endarterectomy. Patient and surgeon selection. Stroke, 28(2), 291-296.

Disciplines

Medicine and Health Sciences | Other Medical Specialties | Surgery

PubMedID

9040677

Department(s)

Department of Community Health and Health Studies, Department of Surgery, Department of Surgery Faculty

Document Type

Article