Journal List > J Korean Surg Soc > v.77(3) > 1011006

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Lee, Lee, Chung, Kim, Byun, Jeon, Kim, Kim, and Kim: Carotid Endarterectomy: Analysis of Early Complications (<30 days) and Risk Factors for Postoperative New Brain Infarction
Original Article
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2009; 77(3): 195-201.

Published online: 4 September 2009

DOI: https://doi.org/10.4174/jkss.2009.77.3.195

Carotid Endarterectomy: Analysis of Early Complications (<30 days) and Risk Factors for Postoperative New Brain Infarction

Kyung-Bok Lee, M.D., Kwang-Ho Lee, M.D.1, Chin-Sang Chung, M.D.1, Gyeong-Moon Kim, M.D.1, Hong-Sik Byun, M.D.2, Pyoung Jeon, M.D.2, Keon-Ha Kim, M.D.2, Dong-Ik Kim, M.D., Young-Wook Kim, M.D.

Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

1Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

2Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Corresponding author (ywkim@skku.edu)

Received 16 May 2009       Accepted 2 July 2009

Copyright © 2009 The Korean Surgical Society

Abstract

Purpose

We aimed to evaluate the early (<30 days) results and to analyze risk factors for the development of stroke and new brain infarction (NBI) after carotid endarterectomy (CEA).

Methods

From September 2003 to August 2008, 233 CEAs were performed on 222 patients with critical internal carotid artery (ICA) stenosis in a single center. Patient characteristics, history of neurological symptoms, procedural details, and postoperative complications were examined based on the medical records. The incidence and risk factors for early postoperative stroke were evaluated. After excluding CEAs without performing diffusion-weighted brain MRI, 128 CEAs were investigated for frequency and the risk factors of NBI were analyzed. Chi-square test, Fisher's exact test, Student T-test, and logistic regression model were used for statistical analysis.

Results

Of a total of 233 CEAs, any and ipsilateral stroke rates were 1.3% and 0.4%, respectively. There was no early postoperative mortality. Early postoperative complications included 4.3% in transient cranial nerve injury, 1.7% in myocardial infarction, and 3.4% in hematoma. In univariate analysis, the significant risk factor for stroke was plaque ulceration (P=0.04). The frequency of NBI and ipsilateral NBI were 8.4% and 3.1%, respectively. The ulceration on ipsilateral ICA revealed statistically significant risk factors for the development of NBI (RR, 5.29; 95% CI, 1.024~27.325; P=0.04).

Conclusion

Our study showed a lower incidence of stroke and NBI after carotid endarterectomy and that it is safe procedure for the treatment of patients with severe (>70%) carotid stenosis. We also found that plaque with ulceration was a significant risk factor for the development of postoperative NBI.

Keywords: Endarterectomy, Carotid artery, Stroke, Brain infarction, Risk factors

Figures and Tables

Fig. 1
Carotid endarterectomy with patch closure.
jkss-77-195-g001
Fig. 2
New brain infarction after carotid endarterectomy.
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Table 1
Characteristics of patients and carotid lesions
jkss-77-195-i001

*Mean±SD; †ICA = internal carotid artery; ‡TIA = transient ischemic attack; §High stenosis = ICA stenosis above C2 body; ∥SCr = serum creatinine; COPD = chronic obstructive pulmonary disease.

Table 2
Details of carotid endarterectomy
jkss-77-195-i002

*CEA = carotid endarterectomy; †CABG = coronary artery bypass graft; ‡AAA = abdominal aortic aneurysm; §CFA = common femoral artery.

Table 3
Early (<30 days) postoperative complications
jkss-77-195-i003

*CEA = carotid endarterectomy; †Hyperperfusion syndrome defined as severe ipsilateral headache with nausea/vomiting, focal neurologic sings, or intracerebral hemorrhage.

Table 4
Risk factor analyses for development of stroke and new brain infarction (NBI) on diffusion-weighted MRI
jkss-77-195-i004

*ICA = internal carotid artery; †DM = diabetes mellitus; ‡CAD = coronary artery disease; §AF = atrial fibrillation; ∥CABG = coronary artery bypass graft.

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