Does the high-risk patient for carotid endarterectomy really exist?

Background: High surgical risk is advocated as a major criterion for carotid artery stenting. To date, definitely accepted criteria to identify "high-risk" patients for carotid endarterectomy (CEA) do not exist. The aim of this study was to analyze the statistical weight of each single previously described risk factor on early and late results after carotid surgery in our experience.

Methods: A retrospective review of 1,883 CEAs performed during a 6-year period in a single institution was performed. Early and late results in terms of mortality and neurologic events were recorded. Univariate and multivariate analysis for early and late risk of stroke and death were performed, considering the influence of age, sex, comorbidities, clinical symptoms, and anatomic features.

Results: The cumulative 30-day stroke and death rate was 1.3%. Univariate analysis and logistic regression did not show statistical significance for 30-day results in any of the considered variables. The three-year stroke-free survival was 94.5%, and it was significantly affected by chronic renal failure, respiratory insufficiency, and older age.

Conclusions: Carotid endarterectomy is a safe procedure also in so-called high-risk subsets of patients. Severe comorbidities seem to affect only long-term survival.