Pothof AB, et al. - Researchers sought to provide an update on 30-day outcomes after carotid endarterectomy (CEA), stratified by type of preprocedural neurologic symptom. Among symptomatic CEA patients, high perioperative 30-day stroke/death rate was observed among those with a preprocedural stroke, compared with those patients with either a preprocedural hemispheric or ocular transient ischemic attack (TIA). Therefore, they recommended avoiding the common stratification applied to CEA patients, which groups all symptomatic patients, especially as the relative proportion of symptomatic patients with a preprocedural stroke vs those with a hemispheric or ocular TIA will affect the overall outcome for all symptomatic patients after CEA.

Methods

• All CEAs were included from the Targeted Vascular module of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP, 2011-2015).
• Patients were stratified based on type of preprocedural neurologic symptom, that is, asymptomatic, ocular TIA, hemispheric TIA, and stroke.
• With 30-day stroke/death as the primary endpoint, comparison was performed of 30-day outcomes across the groups.

Results

• This study included 16,739 CEA patients; 9,784 of these were asymptomatic (58%).
• Researchers noticed that 1,216 (17%) had a preprocedural ocular TIA, 2,635 (38%) a preprocedural hemispheric TIA, and 3,104 (45%) a preprocedural stroke among the 6,955 symptomatic patients.
• Higher 30-day stroke/death rates were evident among preprocedural stroke patients compared with those with a preprocedural hemispheric TIA, or ocular TIA, or asymptomatic patients (5.0% vs 3.3%, 1.9%, and 1.8%, respectively; all P < .001), primarily owing to differences in perioperative 30-day stroke rates, with 4.1% vs 2.5%, 1.4%, and 1.3%, respectively (all P < .001).