Early-Term Complications after Carotid Endarterectomy and Their Risk Factors: Eight-Year Employment of Local Treatment Protocol of a Russian High-Volume Center

Abstract

<b><i>Background:</i></b> More than 20,000 carotid endarterectomies are performed annually in the Russian Federation. Until now, no studies based on the national carotid data set have been published. The objectives of this study were to evaluate early outcomes after carotid endarterectomy and to identify potential risk factors for major adverse cardiovascular events. <b><i>Materials and Methods:</i></b> The retrospective analysis was based on data recorded in a single-center registry, including all carotid endarterectomies performed between 2010 and 2017. A univariate analysis was used to identify the risk factors for perioperative mortality, and predictors of stroke were determined using a multivariate logistic regression model. <b><i>Results:</i></b> Data from 1,832 patients with a mean age of 64.1 ± 7.6 years were analyzed. The combined in-hospital mortality was 0.65% (12/1,832). The rate of stroke was 0.7% (13/1,832), and the rate of myocardial infarction was 1.1% (20/1,832). The 30-day stroke-free survival was 99%. A history of stroke (<i>p</i> = 0.02) and chronic obstructive pulmonary disease (COPD; <i>p</i> = 0.0001) were found to be predictive of a lethal stroke. Previous myocardial infarction (<i>p</i> = 0.0001), an advanced stage of congestive heart failure (<i>p</i> = 0.0001), and angina pectoris (<i>p</i> = 0.01) were associated with cardiac-related mortality. Moreover, diabetes mellitus (<i>p</i> = 0.03), COPD (<i>p</i> = 0.0001), and carotid calcinosis (<i>p</i> = 0.006) increased the risk of poor survival due to myocardial infarction. The mean duration of clamping was found to be an independent predictor of any perioperative stroke (OR = 1.109; 95% CI 1.052–1.129; <i>p</i> &#x3c; 0.0001). <b><i>Conclusions:</i></b> The present retrospective analysis of the local carotid surgery register showed appropriate outcomes after CEA regarding the cumulative incidence of MACE, which is comparable to previously published international register data. A previous history of stroke, myocardial infarction, COPD, a prolonged clamping time during CEA, and diabetes mellitus were found to be factors of high-risk for cardiovascular mortality. A prolonged clamping was identified as an independent predictor of any stroke.