Artikel
Estimation of perioperative risk in carotid endarterectomy: A risk group classification
Perioperative Risikoabschätzung bei Karotisendarteriektomie: Risikogruppeneinteilung
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Autoren
Veröffentlicht: | 23. April 2004 |
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Gliederung
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Objective
According to NASCET- and ECST-study carotid endarterectomy (CEA) reduces the risk of stroke in patients with symptomatic severe carotid stenosis. However there is still a risk of perioperative complications of about 5%. We tried to identify defined risk groups for perioperative ischemic incidents in our patients whose multilocular vascular pathology necessitated a neurosurgical intervention to avoid perioperative stroke.
Methods
Two hundred and eighteen CEAs were performed in 208 patients either uni - or bilaterally. In order to find a potential risk profile, patients were devided into groups with and without perioperative ischemic incident. To ascertain whether incident of risk factors were accidental or based on certain risk criteria, statistical analysis was performed with the Chiquadrat Test and the Jonckheere -Terpstra Test.
Results
Ten patients suffered a perioperative ischemic event (4.8%). Rates for individual complications were as follows: Non disabling stroke, 4 patients (1.9%); major stroke, 4 patients (1.9%); amaurosis, 2 patients (1.0%).The statistical analysis showed an increased risk for ipsilateral stroke (p?0.001) by contralateral occlusion or high grade stenosis, more profoundly clinical symptom status before the operation (major strokes, minor strokes, transient ischemic attack), and by the existence of numerous risk factors for arteriosclerosis. All patients with perioperative complications belonged to the high risk group.
Conclusions
The existence of predictive factors for the appearance of perioperative ischemic incidents in candidates for CEA will help to identify patients with a pronounced risk of perioperative complications; these should be operated on using meticulous policy such as microsurgical technique, intraoperative monitoring and neuroprotective measures.