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KMID : 0371320090770030195
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Journal of the Korean Surgical Society
2009 Volume.77 No. 3 p.195 ~ p.201
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Carotid Endarterectomy: Analysis of Early Complications (＜30 days) and Risk Factors for Postoperative New Brain Infarction
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Lee Koung-Bok
Kim Young-Wook
Kim Dong-Ik
Chung Chin-Sang
Kim Gyeong-Moon
Lee Kwang-Ho
Kim Keon-Ha
Byun Hong-Sik
Jeon Pyoung
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Abstract
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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. (J Korean Surg Soc 2009;77:195-201)
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KEYWORD
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Endarterectomy, Carotid artery, Stroke, Brain infarction, Risk factors
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