A study of carotid endarterectomy in a Chinese population: Initial experience at a single center

Abstract

Objective

This retrospective study aimed to evaluate our initial experience with carotid endarterectomy in a Chinese population.

Methods

Four hundred and thirty-three patients who underwent carotid endarterectomies at Xuan Wu Hospital Capital Medical University between January 1, 2001, and December 31, 2012, were reviewed. The postoperative 30-day complications were analyzed. Univariate and multivariate logistic regression analyses were used to analyze the factors associated with perioperative stroke and death.

Results

The overall 30-day complication rates after surgery were 4.08% for death and stroke, 3.63% for cranial nerve injuries, and 3.63% for heart complications. The mean follow-up time was 32.99 months, and only 11 cases required restenosis, including two that were symptomatic (experiencing transient ischemic attacks). In the univariate analysis, a history of cerebral infarction was present preoperatively in 179 patients, of whom 12 (6.70%) had a postoperative stroke or died (P = 0.021). Thirty-two patients had a modified Ranking score (mRS) ≥ 3, and six (18.75%) of these patients had a postoperative stroke or died (P < 0.001). In the multivariate logistic regression, female gender (OR: 4.669; 95% CI: 1.238–17.602; P = 0.023), current smoking habits (OR: 3.826; 95% CI: 1.298–11.277; P = 0.015), and an mRS ≥ 3 (OR: 1.540; 95% CI: 3.844–40.909; P < 0.001) were independent risk factors for perioperative stroke and death.

Conclusions

In our single-center study, carotid endarterectomies appeared to effectively prevent and treat the carotid artery stenosis that leads to stroke. Female gender, current smoking habits, and neurological deficits (mRS ≥ 3) increased the perioperative stroke and death rates.

Introduction

CEA has been the recommended optimal therapy for carotid stenosis. Many studies, such as The North American Symptomatic Carotid Endarterectomy Trial (NASCET), the European Carotid Surgery Trial (ECST), and the Asymptomatic Carotid Atherosclerosis Study (ACAS), have shown the efficacy and safety of carotid endarterectomy (CEA) in preventing cerebral strokes [1], [2], [3].

The NASCET assessed patients with stenosis >70% and the ECST assessed patients with stenosis of 70–99%, with both trials demonstrating that CEA is more effective than medication therapy. A meta-analysis showed that for patients with stenosis of 50–69%, CEA has some efficacy, whereas in patients with stenosis >70%, CEA is highly effective.

These studies demonstrated that in cases in which the indications for surgery are well assessed, CEA is safe and effective in reducing the morbidity of strokes.

However, as carotid artery stenting has provided another treatment method [5], the controversy over CEA and CAS still continues. Initially, CAS was considered preferable over CEA in high-risk patients; however, it has been shown recently that CEA is also suitable in the elderly, for whom age itself is also a high-risk factor [6].

In China, the morbidity of strokes has been 1.88% but has increased recently to 8.1%; therefore, the prevention of strokes is a serious issue that must be addressed. Since 2009, more efforts have been directed toward the screening and prevention of stroke in China, and more high-risk stroke patients have been treated [7]. However, the efficacy and safety of CEAs have not been thoroughly investigated because of a previous lack of attention to stroke prevention and physician training, and the outcomes following CEAs in the Chinese population are not clear. Therefore, we analyzed our initial experiences with CEA in a Chinese population based on the data on CEAs collected from the neurosurgery department of Xuan Wu Hospital Capital Medical.