@article{c8da3e505b6b403abbb7563897d4cfb8,
title = "Risk factors for stroke, myocardial infarction, or death following carotid endarterectomy: Results from the International Carotid Stenting Study.",
abstract = "Objectives Carotid endarterectomy (CEA) is standard treatment for symptomatic carotid artery stenosis but carries a risk of stroke, myocardial infarction (MI), or death. This study investigated risk factors for these procedural complications occurring within 30 days of endarterectomy in the International Carotid Stenting Study (ICSS). Methods Patients with recently symptomatic carotid stenosis >50% were randomly allocated to endarterectomy or stenting. Analysis is reported of patients in ICSS assigned to endarterectomy and limited to those in whom CEA was initiated. The occurrence of stroke, MI, or death within 30 days of the procedure was reported by investigators and adjudicated. Demographic and technical risk factors for these complications were analysed sequentially in a binomial regression analysis and subsequently in a multivariable model. Results Eight-hundred and twenty-one patients were included in the analysis. The risk of stroke, MI, or death within 30 days of CEA was 4.0%. The risk was higher in female patients (risk ratio [RR] 1.98, 95% CI 1.02-3.87, p = .05) and with increasing baseline diastolic blood pressure (dBP) (RR 1.30 per +10 mmHg, 95% CI 1.02-1.66, p = .04). Mean baseline dBP, obtained at the time of randomization in the trial, was 78 mmHg (SD 13 mmHg). In a multivariable model, only dBP remained a significant predictor. The risk was not related to the type of surgical reconstruction, anaesthetic technique, or perioperative medication regimen. Patients undergoing CEA stayed a median of 4 days before discharge, and 21.2% of events occurred on or after the day of discharge. Conclusions Increasing diastolic blood pressure was the only independent risk factor for stroke, MI, or death following CEA. Cautious attention to blood pressure control following symptoms attributable to carotid stenosis could reduce the risks associated with subsequent CEA.",
keywords = "Carotid artery stenosis, Carotid atherosclerosis, Carotid endarterectomy",
author = "D Doig and E Turner and J Dobson and R Featherstone and {de Borst}, G and G Stansby and J Beard and S Engelter and T Richards and Martin Brown and {International carotid stenting study investigators} and Jorg Ederle and Joanna Dobson and Featherstone, {Roland L.} and Bonati, {Leo H.} and {van der Worp}, {H. Bart} and {de Borst}, {Gert J.} and Lo, {T. Hauw} and Peter Gaines and Dorman, {Paul J.} and Sumaira Macdonald and Lyrer, {Philippe A.} and Hendriks, {Johanna M.} and Charles McCollum and Nederkoorn, {Paul J.} and Nederkoorn, {Paul J.} and Brown, {Martin M.} and A. Algra and J. Bamford and J. Beard and M. Bland and A.W. Bradbury and M.M. Brown and A. Clifton and P. Gaines and W. Hacke and A. Halliday and I. Malik and J.L. Mas and McGuire, {A. J.} and P. Sidhu and G. Venables and A. Bradbury and M.M. Brown and A. Clifton and P. Gaines and R. Collins and A. Molyneux and R. Naylor and C. Warlow and J.M. Ferro and D. Thomas and Bonati, {Leo H.} and L. Coward and J. Dobson and Jorg Ederle and Featherstone, {Roland F.} and H. Tindall and McCabe, {Dominick J.H.} and A. Wallis and M. Brooks and Chambers, {Brian R.} and A. Chan and P. Chu and D. Clark and H. Dewey and Donnan, {Geoffrey A.} and G. Fell and M. Hoare and M. Molan and A. Roberts and N. Roberts and B. Beiles and Chris Bladin and C. Clifford and G. Fell and M. Grigg and G. New and R. Bell and S. Bower and W. Chong and M. Holt and A. Saunder and Than, {P. G.} and S. Gett and D. Leggett and T. McGahan and J. Quinn and M. Ray and A. Wong and P. Woodruff and R. Foreman and David Schultz and R. Scroop and B. Stanley and B. Allard and N. Atkinson and W. Cambell and S. Davies and P. Field and P. Milne and P. Mitchell and B. Tress and B. Yan and A. Beasley and Dunbabin, {David W.} and D. Stary and S. Walker and P. Cras and O. d'Archambeau and Hendriks, {Johanna M.H.} and {van Schil}, Paul and M. Bosiers and K. Deloose and {van Buggenhout}, E. and {De Letter}, J. and V. Devos and J. Ghekiere and G. Vanhooren and P. Astarci and F. Hammer and V. Lacroix and Andre Peeters and R. Verhelst and L. DeJaegher and J. Verbist and J-F. Blair and Caron, {J. L.} and N. Daneault and M-F. Giroux and F. Guilbert and S. Lanthier and L-H Lebrun and V. Oliva and J. Raymond and D. Roy and G. Soulez and A. Weill and M. Hill and W. Hu and M. Hudion and William Morrish and G. Sutherland and J. Wong and A. Alb{\"a}ck and H. Harno and P. Ij{\"a}s and M. Kaste and M. Lep{\"a}ntalo and S. Mustanoja and T. Paananen and M. Porras and J. Putaala and M. Railo and T. Sairanen and L. Soinne and A. Vehmas and P. Vikatmaa and M. Goertler and Z. Halloul and M. Skalej and P. Brennan and C. Kelly and A. Leahy and J. Moroney and J. Thornton and Koelemay, {P J.} and Nederkoorn, {Paul J.} and Reekers, {J A A.} and Roos, {Y B W E M.} and Hendriks, {J M.} and Koudstaal, {P J.} and Pattynama, {P M T.} and {van der Lugt}, A. and {van Dijk}, {L C.} and {van Sambeek}, {M R H M.} and {van Urk}, H. and Verhagen, {H J M.} and Bruijninckx, {C M A.} and {de Bruijn}, {S F.} and R. Keunen and B. Knippenberg and A. Mosch and F. Treurniet and {van Dijk}, L. and {van Overhagen}, H. and J. Wever and {de Beer}, {F C.} and {van den Berg}, {J. S.P.} and {van Hasselt}, {B A A M.} and Zeilstra, {D J.} and J. Boiten and {de Mol van Otterloo}, {J C A.} and {de Vries}, {A C.} and {Lycklama a Nijeholt}, {G J.} and {van der Kallen}, {B F W.} and Blankensteijn, {J D.} and {de Leeuw}, {Frank Erik} and {Schultze Kool}, {L J.} and {van der Vliet}, {J A.} and {de Borst}, {Gert J.} and {de Kort}, {G A P.} and Kapelle, {L. Jaap} and Lo, {T. Hauw} and Mali, {W P TH M.} and F. Moll and {van der Worp}, {H. Bart} and H. Verhagen and Barber, {P A.} and R. Bourchier and Andrew Hill and A. Holden and J. Stewart and Bakke, {S. J.} and K. Krohg-S{\o}rensen and M. Skjelland and B. Tenn{\o}e and P. Bialek and Z. Biejat and W. Czepiel and A. Czlonkowska and A. Dowzenko and J. Jedrzejewska and A. Kobayashi and M. Lelek and J. Polanski and J. Kirbis and Z. Milosevic and B. Zvan and J. Blasco and A. Chamorro and J. Macho and V. Obach and Vicente Riambau and {San Roman}, L. and J. Branera and D. Canovas and Jordi Estela and {Gimenez Gaibar}, A. and J. Perendreu and K. Bj{\"o}rses and A. Gotts{\"a}ter and K. Ivancev and T. Maetzsch and B. Sonesson and B. Berg and M. Delle and J. Formgren and P. Gillgren and T-B Kall and T-B Konrad and N. Nyman and R. Takolander and T. Andersson and J. Malmstedt and M. Soderman and C. Wahlgren and N. Wahlgren and S. Binaghi and L. Hirt and P. Michel and P. Ruchat and Leo Bonati and Engelter, {Stefan T.} and F. Fluri and L. Guerke and Jacob, {A L.} and E. Kirsch and Lyrer, {Philippe A.} and E-W Radue and P. Stierli and M. Wasner and S. Wetzel and C. Bonvin and A. Kalangos and K. Lovblad and N. Murith and D. Ruefenacht and R. Sztajzel and N. Higgins and Kirkpatrick, {P J.} and P. Martin and K. Varty and D. Adam and J. Bell and A.W. Bradbury and P. Crowe and M. Gannon and Henderson, {M J.} and D. Sandler and Shinton, {R. A.} and Scriven, {J M.} and T. Wilmink and S. D'Souza and A. Egun and A. Guta and S. Punekar and Seriki, {D. M.} and G. Thomson and Brennan, {J A.} and Enevoldson, {T P.} and G Gilling-Smith and Gould, {D A.} and Harris, {P L.} and McWilliams, {R G.} and H-C Nasser and R. White and Prakash, {K G.} and F. Serracino-Inglott and G. Subramanian and Symth, {J V.} and Walker, {M G.} and M. Clarke and M. Davis and Dixit, {S A.} and P. Dorman and A. Dyker and G. Ford and A. Golkar and R. Jackson and V. Jayakrishnan and D. Lambert and T. Lees and S. Louw and S. Macdonald and Mendelow, {A D.} and H. Rodgers and J. Rose and G. Stansby and M. Wyatt and T. Baker and N. Baldwin and L. Jones and D. Mitchell and E. Munro and M. Thornton and D. Baker and N. Davis and G. Hamilton and D. McCabe and A. Platts and J. Tibballs and J. Beard and Trevor Cleveland and D. Dodd and P. Gaines and R. Lonsdale and R. Nair and A. Nassef and S. Nawaz and G. Venables and A. Belli and A. Clifton and Geoff Cloud and A. Halliday and Hugh Markus and R. McFarland and R. Morgan and Anthony Pereira and A. Thompson and J. Chataway and N. Cheshire and R. Gibbs and M. Hammady and M. Jenkins and I. Malik and J. Wolfe and M. Adiseshiah and C. Bishop and S. Brew and J. Brookes and Brown, {Martin M.} and R. J{\"a}ger and N. Kitchen and R. Ashleigh and S. Butterfield and Gamble, {G E.} and C. McCollum and A. Nasim and P. O'Neill and J. Wong and Edwards, {R D.} and Lees, {K R.} and MacKay, {A J.} and J. Moss and P. Rogers",
year = "2015",
month = dec,
doi = "10.1016/j.ejvs.2015.08.006",
language = "English",
volume = "50",
pages = "688--694",
journal = "European Journal of Vascular and Endovascular Surgery",
issn = "1078-5884",
publisher = "W.B. Saunders Ltd",
number = "6",
}