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Gender-specific risk of perioperative complications in carotid endarterectomy patients with contralateral carotid artery stenosis or occlusion

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Abstract.

Carotid endarterectomy (CEA) has been shown to be effective in stroke prevention in selected patients. Some studies, however, identified gender as an independent risk factor for perioperative CEA complications demonstrating an increased rate of perioperative stroke or death in women. Furthermore, contralateral internal carotid artery (ICA) occlusion has been associated with higher rates of perioperative CEA complications. Therefore, we sought to analyse the gender-specific risk of perioperative CEA complications between patients with or without contralateral ICA stenosis or occlusion. We retrospectively analysed 212 consecutive CEA patients (male = 156, Female = 56) for their gender-specific, perioperative risk of stroke, transient ischemic attack (TIA), restenosis and cardiac complications in the presence (62%) or absence (38%) of a contralateral ICA stenosis/occlusion. In women but not in men, risk of perioperative ischemic events (stroke, TIA) or re-stenosis (p = 0.036) and combined perioperative complications (ischemic events, re-stenosis or cardiac complications; 38.2 % vs. 9.1%; p = 0.028) was significantly increased in the presence of a contralateral ICA stenosis or occlusion. Furthermore, in the presence of a contralateral ICA stenosis/occlusion the number of perioperative ischemic events (p = 0.008) and combined perioperative complications (38.2 % vs. 14.3%; p = 0.006) was significantly higher in female than in male patients. Our study suggests that women with contralateral ICA stenosis or occlusion may have a significantly higher risk for perioperative CEA complications than other subgroups of CEA patients. This risk increase seems to be gender-specific and, if confirmed in larger prospective studies, may influence ICA stenosis therapy in the presence of a contralateral ICA stenosis/occlusion in female patients.

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References

  1. AbuRahma AF, Robinson P, Holt SM, Herzog TA, Mowery NT (2000) Perioperative and late stroke rates of carotid endarterectomy contralateral to carotid artery occlusion: results from a randomised trial. Stroke 31:1566–1571

    CAS  PubMed  Google Scholar 

  2. Ackerstaff R, Jansen C, Moll F, Vermeulen F, Hamerlijnck R, Mauser H (1995) The significance of microemboli detection by means of transcranial Doppler ultrasonography monitoring in carotid endarterectomy. J Vasc Surg 21:963–969

    CAS  PubMed  Google Scholar 

  3. Adelman MA, Jacobowitz GR, Riles TS, Imparato AM, Lamparello PJ, Baumann FG, Landis R (1995) Carotid endarterectomy in the presence of a contralateral occlusion: a review of 315 cases over a 27-year experience. Cardiovasc Surg 3:307–312

    Article  CAS  PubMed  Google Scholar 

  4. Akbari CM, Pulling MC, Pomposelli FB Jr, Gibbons GW, Campbell DR, Logerfo FW (2000) Gender and carotid endarterectomy: does it matter? J Vasc Surg 31:1103–1108

    Article  CAS  PubMed  Google Scholar 

  5. Appleberg M, Cottier D, Crozier J, Graham J, Lane R (1995) Carotid endarterectomy for asymptomatic carotid artery stenosis: patients with severe bilateral disease a high risk subgroup. Aust NZJ Surg 65:160–165

    CAS  Google Scholar 

  6. Aungst M, Gahtan V, Berkowitz H, Roberts AB, Kerstein MD (1998) Carotid endarterectomy outcome is not affected in patients with a contralateral carotid artery occlusion. Am J Surg 176:30–33

    Article  CAS  PubMed  Google Scholar 

  7. Ballotta E, DaGiau G, Renon L (1999) Early and late outcomes of young patients after carotid endarterectomy. Surgery 125:581–586

    Article  CAS  PubMed  Google Scholar 

  8. Bond R, Narayan SK, Rothwell PM, Warlow CP (2002) The European Carotid Surgery Trialists’ Collaborative Group. Clinical and radiographic risk factors for operative stroke and death in the European carotid surgery trial. Eur J Vasc Endovasc Surg 2:108–116

    Article  Google Scholar 

  9. Boontje AH (1994) Carotid endarterectomy without a temporary indwelling shunt: result and analysis of back pressure measurements. Cardiovasc Surg 2:549–553

    CAS  PubMed  Google Scholar 

  10. European Carotid Surgery Trialists’ Collaborative Group (1991) MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70–99%) or with mild (0–29 %) carotid stenosis. Lancet 337:1235–1243

    Article  PubMed  Google Scholar 

  11. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study (1995) Endarterectomy for asymptomatic carotid artery stenosis. JAMA 273:1421–1428

    PubMed  Google Scholar 

  12. Ferguson GG, Eliasziw M, Barr HWK, Clagett GP, Barnes RW, Wallace MC, Taylor DW, Haynes RB, Finan JW, Hachinski VC, Barnett HJM for the North American Symptomatic Carotid Endarterectomy Trial Collaborators (1999) The North American Symptomatic Carotid Endarterectomy Trial: Surgical results in 1415 patients. Stroke 30:1751–1758

    CAS  PubMed  Google Scholar 

  13. Gasecki AP, Eliasziw M, Ferguson GG, Hachinski V, Barnett HJM for the North American symptomatic carotid endarterectomy trial (NASCET) group (1995) Long-term prognosis and effect of endarterectomy in patients with symptomatic severe carotid stenosis and contralateral carotid stenosis or occlusion: results from NASCET. J Neurosurg 83:778–782

    CAS  PubMed  Google Scholar 

  14. Goldstein LB, Samsa GP, Matchar DB, Oddone EZ (1998) Multicenter review of preoperative risk factors for endarterectomy for asymptomatic carotid artery stenosis. Stroke 29:750–753

    CAS  PubMed  Google Scholar 

  15. Gorelick PB (1999) Carotid endarterectomy—where do we draw the line? Stroke 30:1745–1750

    CAS  PubMed  Google Scholar 

  16. Hamdan AD, Pomposelli FB Jr, Gibbons GW, Campbell DR, LoGerfo FW (1999) Perioperative strokes after 1001 consecutive carotid endarterectomy procedures without an electroencephalogram: incidence, mechanism and recovery. Arch Surg 134:412–415

    Article  CAS  PubMed  Google Scholar 

  17. Hertzer NR, O’Hara PJ, Mascha EJ, Krajewski LP, Sullivan TM, Beven EG (1997) Early outcome assessment for 2228 consecutive carotid endarterectomy procedures: the Cleveland Clinic experience from 1989 to 1995. J Vasc Surg 26:1–10

    CAS  PubMed  Google Scholar 

  18. James DC, Hughes JD, Mills JL, Westerband A (2001) The influence of gender on complications of carotid endarterectomy. Am J Surg 182:654–657

    Article  CAS  PubMed  Google Scholar 

  19. Laman DM, Wieneke GH, Van Duijn H, Van Huffelen AC (2002) High embolic rate early after carotid endarterectomy is associated with early cerebrovascular complications, especially in women. J Vasc Surg 36:1–7

    Article  PubMed  Google Scholar 

  20. Levi CR, O’Malley HM, Fell G, Roberts AK, Hoare MC, Royle JP, Chan A, Beiles B, Chambers BR, Bladin CF, Donnan GA (1997) Transcranial Doppler detected cerebral microembolism following carotid endarterectomy: high microembolic signal loads predict postoperative cerebral ischemia. Brain 120:621–629

    Article  PubMed  Google Scholar 

  21. Mattos MA, Sumner DS, Bohannon WT, Parra J, McLafferty RB, Karch LA, Ramsey DE,Hodgson KJ (2001) Carotid endarterectomy in women—challenging the results from ACAS and NASCET. Ann Surg 234:438–446

    Article  CAS  PubMed  Google Scholar 

  22. McCrory DC, Goldstein LB, Samsa GP, Oddone EZ, Landsman PB, Moore WS, Matchar DB (1993) Predicting complications of carotid endarterectomy. Stroke 24:1285–1291

    CAS  PubMed  Google Scholar 

  23. North American Symptomatic Carotid Endarterectomy Trial Collaborators (1991) Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 325:445–453

    PubMed  Google Scholar 

  24. Perler BA, Burdick JF, Williams GM (1992) Does contralateral internal carotid artery occlusion increase the risk of carotid endarterectomy? J Vasc Surg 16:347–352

    Article  CAS  PubMed  Google Scholar 

  25. Rothwell PM, Slattery J, Warlow CP (1996) A systematic review of the risks of stroke and death due to endarterectomy for symptomatic carotid stenosis. Stroke 27:260–265

    CAS  PubMed  Google Scholar 

  26. Rothwell PM, Slattery J,Warlow CP (1997) Clinical and angiographic predictors of stroke and death from carotid endarterectomy: systematic review. BMJ 315:1571–1577

    CAS  PubMed  Google Scholar 

  27. Samson RH, Showalter DP, Yunis JP (1998) Routine carotid endarterectomy without a shunt, even in the presence of a contralateral occlusion. Cardiovasc Surg 6:475–484

    Article  CAS  PubMed  Google Scholar 

  28. Sarac TP, Hertzer NR, Mascha EJ, O’Hara PJ, Krajewski LP, Clair DG, Karafa MT, Ouriel K (2002) Gender as a primary predictor of outcome after carotid endarterectomy. J Vasc Surg 35:748–753

    Article  PubMed  Google Scholar 

  29. Sternbach Y, Perler BA (2000) The influence of female gender on the outcome of carotid endarterectomy: a challenge to the ACAS findings. Surgery 127:272–275

    Article  CAS  PubMed  Google Scholar 

  30. Stork JL, Levi CR, Chambers BR, Abbott AL, Donnan GA (2002) Possible determinants of early microembolism after carotid endarterectomy. Stroke 33:2082–2085

    Article  PubMed  Google Scholar 

  31. Subramaniam P, Stary D, Scott A (1995) Carotid surgery in Northern Tasmania: a retrospective view. Aust N Z J Surg 65:480–484

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Dept. of Neurology, University of Goettingen Medical School, Robert-Koch-Str. 40, 37075, Goettingen, Germany

    Jens Weise MD & Mathias Bähr

  2. Dept. of Neurology, University of Tuebingen Medical School, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany

    Sascha Kuschke

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  1. Jens Weise MD
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  2. Sascha Kuschke
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Correspondence to Jens Weise MD.

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Weise, J., Kuschke, S. & Bähr, M. Gender-specific risk of perioperative complications in carotid endarterectomy patients with contralateral carotid artery stenosis or occlusion. J Neurol 251, 838–844 (2004). https://doi.org/10.1007/s00415-004-0438-8

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  • DOI: https://doi.org/10.1007/s00415-004-0438-8

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