Impact of acute cerebral ischemic lesions and their volume on the revascularization outcome of symptomatic carotid stenosis (original) (raw)

2016, Journal of Vascular Surgery

Background: The influence of acute cerebral ischemic lesions (CILs) on the revascularization outcome of symptomatic carotid stenosis has been scarcely investigated in the literature. This study evaluated the effect of CILs and their volume on the results of carotid revascularization in symptomatic patients. Methods: All patients with symptomatic carotid artery stenosis who underwent carotid endarterectomy (CEA) or carotid artery stenting (CAS) between 2005 and 2014 were considered. CILs ipsilateral to the stenosis were identified in the preoperative cerebral computed tomography. The volume was quantified in mm 3 and correlated with 30-day rates of stroke and stroke/death by c 2 , multivariate analysis, Pearson correlation, and receiver operating characteristic curves. Results: A total of 489 symptomatic patients were treated by CEA (327 [67%]) or CAS (162 [33%]), 186 (38%) #2 weeks and 303 (62%) >2 weeks from symptom onset. CEA and CAS patients had statistically similar rates of stroke (3.3% vs 5.5%; P ¼ .27) and stroke/death (3.8% vs 5.9%; P ¼ .22). CILs were identified in 251 patients (53%) and were associated with similar stroke and stroke/death rate compared with patients without CIL (12 [4.8%] vs 8 [3.5%], P ¼ .46; and 14 [5.6%] vs 8 [3.5%]; P ¼ .26, respectively). The median CIL volume was 1000 mm 3 (interquartile range [IQR], 7000 mm 3). Patients with postoperative stroke and stroke/death had a significantly higher preoperative CIL volume of 5100 mm 3 (IQR, 31,000 mm 3) vs 1000 mm 3 (IQR, 7000 mm 3 ; P ¼ .01) and 4500 mm 3 (IQR, 17,450 mm 3) vs 1000 mm 3 (IQR, 7000 mm 3 ; P ¼ .03), respectively. The receiver operating characteristic curve analysis showed a volume of 4000 mm 3 was predictive of postoperative stroke with 75% sensitivity and 63% specificity. A CIL volume 4000mm3wasanindependentriskfactorforpostoperativestroke,withastrokerateof9.34000 mm 3 was an independent risk factor for postoperative stroke, with a stroke rate of 9.3% (n ¼ 9) vs 1.9% (n ¼ 3) for a CIL volume of <4000 mm 3 (odds ratio, 4.6; 95% confidence interval, 1.1-19.1; P ¼ .03). Conclusions: CIL volume in symptomatic carotid stenosis seems to influence the 30-day outcome independently from the timing of carotid revascularization. A CIL volume of 4000mm3wasanindependentriskfactorforpostoperativestroke,withastrokerateof9.34000 mm 3 could be considered a significant predictor for postoperative stroke after carotid revascularization.