Risk Factors Associated with Ipsilateral Ischemic Events Following Carotid Endarterectomy for Carotid Artery Stenosis

Xiaoming Rong, Wuyang Yang, Tomas Garzon-Muvdi, Xiaobu Ye, Justin Caplan, Geoffrey P. Colby, Alexander Coon, Rafael J Tamargo, Judy Huang

Research output: Contribution to journalArticle

Abstract

Objective: Patients undergoing carotid endarterectomy (CEA) are at risk of developing ipsilateral stroke or transient ischemic attacks (TIAs). In this study, we explored factors associated with development of these events following CEA in patients with long-term follow-up. Methods: We performed a retrospective analysis of all neurosurgical patients who underwent CEA and presented with ipsilateral ischemic stroke, TIA, or amaurosis fugax. Factors were compared against the outcome variable in univariate analysis. Multivariate logistic regression model was used to identify independent predictive variables. We used Kaplan-Meier analysis (log-rank test) to compare the effect of variables on long-term event-free survival. Results: Our study included 270 patients with an average age of 67.2 years. Two-hundred and forty-nine patients within our study cohort (92.2%) with 273 CEAs were followed at our institution. At presentation, 187 patients (68.5%) were symptomatic. The average follow-up was 50.2 months (113.2 lesion-years). Event-free survival was 91.6% and 89.9% at 2 years and 5 years, respectively. Family history of stroke (P = 0.002), cigarette smoking (P = 0.021), and atrial fibrillation (P = 0.005) significantly increased the risk of adverse events, whereas symptomatic presentation demonstrated a trend toward significance (P = 0.057). A higher risk for ischemic events was observed in female patients as compared with males with asymptomatic presentation (P = 0.005). Conclusions: Our data suggest that family history of stroke, cigarette smoking, and atrial fibrillation are independent risk factors for developing ischemic events after CEA. In patients with asymptomatic presentation, female gender is also a risk factor. Identification of patients at risk is critical for tailored postoperative patient management and patient education.

Original languageEnglish (US)
JournalWorld Neurosurgery
DOIs
StateAccepted/In press - Oct 4 2015

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Carotid Endarterectomy
Carotid Stenosis
Stroke
Transient Ischemic Attack
Atrial Fibrillation
Disease-Free Survival
Logistic Models
Smoking
Amaurosis Fugax
Kaplan-Meier Estimate
Patient Education
Cohort Studies

Keywords

  • Carotid endarterectomy
  • Carotid stenosis
  • Stroke
  • Transient ischemic attack

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Risk Factors Associated with Ipsilateral Ischemic Events Following Carotid Endarterectomy for Carotid Artery Stenosis. / Rong, Xiaoming; Yang, Wuyang; Garzon-Muvdi, Tomas; Ye, Xiaobu; Caplan, Justin; Colby, Geoffrey P.; Coon, Alexander; Tamargo, Rafael J; Huang, Judy.

In: World Neurosurgery, 04.10.2015.

Research output: Contribution to journalArticle

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title = "Risk Factors Associated with Ipsilateral Ischemic Events Following Carotid Endarterectomy for Carotid Artery Stenosis",
abstract = "Objective: Patients undergoing carotid endarterectomy (CEA) are at risk of developing ipsilateral stroke or transient ischemic attacks (TIAs). In this study, we explored factors associated with development of these events following CEA in patients with long-term follow-up. Methods: We performed a retrospective analysis of all neurosurgical patients who underwent CEA and presented with ipsilateral ischemic stroke, TIA, or amaurosis fugax. Factors were compared against the outcome variable in univariate analysis. Multivariate logistic regression model was used to identify independent predictive variables. We used Kaplan-Meier analysis (log-rank test) to compare the effect of variables on long-term event-free survival. Results: Our study included 270 patients with an average age of 67.2 years. Two-hundred and forty-nine patients within our study cohort (92.2{\%}) with 273 CEAs were followed at our institution. At presentation, 187 patients (68.5{\%}) were symptomatic. The average follow-up was 50.2 months (113.2 lesion-years). Event-free survival was 91.6{\%} and 89.9{\%} at 2 years and 5 years, respectively. Family history of stroke (P = 0.002), cigarette smoking (P = 0.021), and atrial fibrillation (P = 0.005) significantly increased the risk of adverse events, whereas symptomatic presentation demonstrated a trend toward significance (P = 0.057). A higher risk for ischemic events was observed in female patients as compared with males with asymptomatic presentation (P = 0.005). Conclusions: Our data suggest that family history of stroke, cigarette smoking, and atrial fibrillation are independent risk factors for developing ischemic events after CEA. In patients with asymptomatic presentation, female gender is also a risk factor. Identification of patients at risk is critical for tailored postoperative patient management and patient education.",
keywords = "Carotid endarterectomy, Carotid stenosis, Stroke, Transient ischemic attack",
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AU - Rong, Xiaoming

AU - Yang, Wuyang

AU - Garzon-Muvdi, Tomas

AU - Ye, Xiaobu

AU - Caplan, Justin

AU - Colby, Geoffrey P.

AU - Coon, Alexander

AU - Tamargo, Rafael J

AU - Huang, Judy

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N2 - Objective: Patients undergoing carotid endarterectomy (CEA) are at risk of developing ipsilateral stroke or transient ischemic attacks (TIAs). In this study, we explored factors associated with development of these events following CEA in patients with long-term follow-up. Methods: We performed a retrospective analysis of all neurosurgical patients who underwent CEA and presented with ipsilateral ischemic stroke, TIA, or amaurosis fugax. Factors were compared against the outcome variable in univariate analysis. Multivariate logistic regression model was used to identify independent predictive variables. We used Kaplan-Meier analysis (log-rank test) to compare the effect of variables on long-term event-free survival. Results: Our study included 270 patients with an average age of 67.2 years. Two-hundred and forty-nine patients within our study cohort (92.2%) with 273 CEAs were followed at our institution. At presentation, 187 patients (68.5%) were symptomatic. The average follow-up was 50.2 months (113.2 lesion-years). Event-free survival was 91.6% and 89.9% at 2 years and 5 years, respectively. Family history of stroke (P = 0.002), cigarette smoking (P = 0.021), and atrial fibrillation (P = 0.005) significantly increased the risk of adverse events, whereas symptomatic presentation demonstrated a trend toward significance (P = 0.057). A higher risk for ischemic events was observed in female patients as compared with males with asymptomatic presentation (P = 0.005). Conclusions: Our data suggest that family history of stroke, cigarette smoking, and atrial fibrillation are independent risk factors for developing ischemic events after CEA. In patients with asymptomatic presentation, female gender is also a risk factor. Identification of patients at risk is critical for tailored postoperative patient management and patient education.

AB - Objective: Patients undergoing carotid endarterectomy (CEA) are at risk of developing ipsilateral stroke or transient ischemic attacks (TIAs). In this study, we explored factors associated with development of these events following CEA in patients with long-term follow-up. Methods: We performed a retrospective analysis of all neurosurgical patients who underwent CEA and presented with ipsilateral ischemic stroke, TIA, or amaurosis fugax. Factors were compared against the outcome variable in univariate analysis. Multivariate logistic regression model was used to identify independent predictive variables. We used Kaplan-Meier analysis (log-rank test) to compare the effect of variables on long-term event-free survival. Results: Our study included 270 patients with an average age of 67.2 years. Two-hundred and forty-nine patients within our study cohort (92.2%) with 273 CEAs were followed at our institution. At presentation, 187 patients (68.5%) were symptomatic. The average follow-up was 50.2 months (113.2 lesion-years). Event-free survival was 91.6% and 89.9% at 2 years and 5 years, respectively. Family history of stroke (P = 0.002), cigarette smoking (P = 0.021), and atrial fibrillation (P = 0.005) significantly increased the risk of adverse events, whereas symptomatic presentation demonstrated a trend toward significance (P = 0.057). A higher risk for ischemic events was observed in female patients as compared with males with asymptomatic presentation (P = 0.005). Conclusions: Our data suggest that family history of stroke, cigarette smoking, and atrial fibrillation are independent risk factors for developing ischemic events after CEA. In patients with asymptomatic presentation, female gender is also a risk factor. Identification of patients at risk is critical for tailored postoperative patient management and patient education.

KW - Carotid endarterectomy

KW - Carotid stenosis

KW - Stroke

KW - Transient ischemic attack

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