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Effect of severe contralateral carotid stenosis or occlusion on early and late outcomes after carotid endarterectomy

Annals of Surgical Treatment and Research 2019년 97권 4호 p.202 ~ 209
 ( Jeong Min-Jae ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery

 ( Kwon Hyun-Wook ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
 ( Kim Min-ju ) - University of Ulsan College of Medicine Asan Medical Center Department of Clinical Epidemiology and Biostatistics
 ( Han Young-Jin ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
 ( Kwon Tae-Won ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
 ( Cho Yong-Pil ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery

Abstract


Purpose: We aimed to compare clinical outcomes after carotid endarterectomy (CEA) between Korean patients with and without severe contralateral extracranial carotid stenosis or occlusion (SCSO).

Methods: Between January 2004 and December 2014, a total of 661 patients who underwent 731 CEAs were stratified by SCSO (non-SCSO and SCSO groups) and analyzed retrospectively. The study outcomes included the occurrence of major adverse cardiovascular events (MACE), defined as stroke or myocardial infarction, and all-cause mortality during the perioperative period and within 4 years after CEA.

Results: There were no significant differences in the incidence of MACE or any individual MACE manifestations between the 2 groups during the perioperative period or within 4 years after CEA. On multivariate analysis to identify clinical variables associated with long-term study outcomes, older age (hazard ratios [HRs], 1.06; 95% confidence intervals [CIs], 1.03?1.09; P < 0.001) and diabetes mellitus (HR, 1.71; 95% CI, 1.14?2.57; P = 0.010) were significantly associated with an increased risk of MACE occurrence, while preexisting SCSO was not associated with long-term incidence of MACE and individual MACE components. Kaplan-Meier survival analysis showed similar MACE-free (P = 0.509), overall (P = 0.642), and stroke-free (P = 0.650) survival rates in the 2 groups.

Conclusion: There were no significant differences in MACE incidence after CEA between the non-SCSO and SCSO groups, and preexisting SCSO was not associated with an increased risk of perioperative or long-term MACE occurrence.

키워드

Carotid endarterectomy; Carotid stenosis; Outcomes; Stroke
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