Perioperative and Long-term Outcomes of Carotid Endarterectomy for Japanese Asymptomatic Cervical Carotid Artery Stenosis: A Single Institution Study

Taichi Ishiguro, Taku Yoneyama, Tatsuya Ishikawa, Koji Yamaguchi, Akitsugu Kawashima, Takakazu Kawamata, Yoshikazu Okada, Taichi Ishiguro, Taku Yoneyama, Tatsuya Ishikawa, Koji Yamaguchi, Akitsugu Kawashima, Takakazu Kawamata, Yoshikazu Okada

Abstract

As the recently developed medical treatments for asymptomatic cervical carotid artery stenosis (ACCAS) have shown excellent stroke prevention, carotid endarterectomy (CEA) should be carried out for more selected patients and with lower complication rates and better long-term outcomes. We have performed CEA for Japanese ACCAS patients with a uniform surgical technique and strict perioperative management. In this study, we retrospectively investigated the perioperative complications and long-term outcomes of our CEA series. A total of 147 CEAs were carried out in 139 Japanese ACCAS patients. All patients were routinely checked for their cardiac function and high risk coronary lesions were preferentially treated before CEA. All CEAs were performed under general anesthesia using a shunt system. The postoperative cerebral blood flow was routinely measured under continued sedation to prevent postoperative hyperperfusion. The 30-day perioperative morbidity rate was 2.04%, including a perioperative stroke rate of 0.68%. There were no perioperative deaths. With regard to the long-term outcomes of the 134 followed-up patients, 9 patients were dead and 5 patients suffered from strokes, including 2 patients with ipsilateral hemispheric ischemia. The annual rates of death, all stroke and ipsilateral ischemic stroke were 1.15%, 0.64%, and 0.25%, respectively. These results showed that the perioperative morbidity and mortality rates of our CEAs were lower than those in the previous large trials. Furthermore, the long-term outcomes of this series were favorable to those reported in the latest medical treatment trials for ACCAS patients. CEA may be useful for preventing ischemic stroke in Japanese ACCAS patients.

Conflict of interest statement

Conflicts of Interest Disclosure

None of the authors have any conflicts of interest (COI) associated with this study. All authors who are members of The Japan Neurological Society (JNS) have registered online Self-reported COI Disclosure Statement Forms through the website for JNS members.

Figures

Fig. 1
Fig. 1
Diagram showing the cervical vertebrae, the distribution of the carotid bifurcation levels, and the distal end of the plaque in surgical patients. The mean carotid bifurcation level is the lower border of C3, and the mean distal end of the stenotic lesion is the C2/C3 level. C: cervical vertebra.
Fig. 2
Fig. 2
The stroke-free (A) and survival curves (B) determined by Kaplan-Meier method. The 5- and 10-year stroke-free rates were 96.4% and 89.6%, respectively. The 5- and 10-year survival rates were 94.6% and 87.9%, respectively.

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Source: PubMed

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