Massachusetts Chapter of the American College of Surgeons

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Postoperative Disability and One-Year Outcomes for Patients Suffering a Stroke After Carotid Endarterectomy
Scott R. Levin, MD, MSc1, Alik Farber, MD, MBA1, Elizabeth G. King, MD1, Mohammad H. Eslami, MD, MPH2, Karan Garg, MD3, Virendra I. Patel, MD, MPH4, Caron B. Rockman, MD3, Denis Rybin, PhD5, Jeffrey J. Siracuse, MD, MBA1
1Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA; 2Division of Vascular and Endovascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; 3Division of Vascular and Endovascular Surgery, NYU Langone Health, New York, NY; 4Section of Vascular Surgery and Endovascular Interventions, NYP-Columbia University Irving Medical Center, New York, NY; 5Department of Biostatistics, Boston University School of Public Health, Boston, MA

Background: Although post-carotid endarterectomy (CEA) stroke is rare, it can be devastating. The degree of disability that patients develop after such an event and its effects on long-term outcomes are unclear. Our goal was to assess the extent of perioperative disability in patients having a stroke after CEA, and evaluate its association with long-term outcomes.
Methods: The Vascular Quality Initiative (2016-2020) was queried for CEAs for asymptomatic or symptomatic indications in patients with preoperative modified Rankin Scale (mRS) scores of 0 or 1. mRS scores stroke-related disability as 0 (none), 1 (not significant), 2-3 (moderate), 4-5 (severe), and 6 (dead). Patients suffering perioperative ipsilateral strokes were included. Perioperative stroke-related disability and its association with long-term outcomes were analyzed.
Results: 1,178 patients had a perioperative ipsilateral stroke. Perioperative stroke-related disability was mRS 0 (11.6%), mRS 1 (19.5%), mRS 2-3 (29.4%), mRS 4-5 (26.9%), and mRS 6 (8%). One-year survival was 91.4% for mRS 0, 95.6% for mRS 1, 92.1% for mRS 2-3, and 81.5% for mRS 4-5 (P<.001). Severe perioperative disability was associated with increased one-year mortality (HR 2.97, 95% CI 1.55.9, P<.001), but not moderate perioperative disability. Severe perioperative disability was associated with increased one-year ipsilateral neurological events or death (HR 2.34, 95% CI 1.254.4, P=.008), but not moderate perioperative disability.
Conclusion: Most patients suffering strokes after CEA developed significant disability. Severe disability was associated with higher one-year mortality and subsequent neurological events. These data can improve informed consent for CEA and guide prognostication after a postoperative stroke.


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