O-039 - A RETROSPECTIVE ANALYSIS OF THE RESULTS OF CAROTID ENDARTERECTOMY FOR ASYMPTOMATIC INTERNAL CAROTID ARTERY PERFORMED IN PATIENTS CANDIDATE OR NOT TO INTERVENTION ON THE BASIS OF THE ESC-ESVS GUIDELINES

TOPIC:
Other
AUTHORS:
Giacomelli E. (Department of Experimental and Clinical Medicine, School of Vascular Surgery, University of Florence ~ Florence ~ Italy) , Di Domenico R. (Department of Experimental and Clinical Medicine, School of Vascular Surgery, University of Florence ~ Florence ~ Italy) , Chiti E. (Department of Experimental and Clinical Medicine, School of Vascular Surgery, University of Florence ~ Florence ~ Italy) , Azas L. (Department of Experimental and Clinical Medicine, School of Vascular Surgery, University of Florence ~ Florence ~ Italy) , Villani F. (Department of Experimental and Clinical Medicine, School of Vascular Surgery, University of Florence ~ Florence ~ Italy) , Paperetti L. (Department of Experimental and Clinical Medicine, School of Vascular Surgery, University of Florence ~ Florence ~ Italy) , Dorigo W. (Department of Experimental and Clinical Medicine, School of Vascular Surgery, University of Florence ~ Florence ~ Italy) , Pulli R. (Department of Experimental and Clinical Medicine, School of Vascular Surgery, University of Florence ~ Florence ~ Italy)
Introduction:
To retrospectively compare perioperative outcomes of carotid endarterectomy (CEA) performed for >60% asymptomatic stenosis in patients with or without preoperative clinical and imaging features suggesting the need for intervention on the basis of the 2018 ESC (European Society of Cardiology)-ESVS (European Society for Vascular and Endovascular Surgery) guidelines.
Methods:
From January 2008 to December 2018, 2501 consecutive CEAs were performed in a single academic institution. Data concerning these interventions were prospectively collected in a dedicated database. A retrospective analysis of the database was performed and 1956 interventions performed in asymptomatic patients were found. Those patients were divided in two subgroups: patients not candidate for intervention on the basis of the 2018 ESC-ESVS guidelines (life expectancy less than 5 years, predominantly hyperechoic plaques on preoperative duplex ultrasound, absence of silent brain infarction at preoperative computed-tomography scan; 876 interventions, group 1) and patients fulfilling the suggested indications (1080 interventions, group 2). The two groups were compared in term of clinical, anatomical and surgical characteristics and of perioperative (<30 days) outcomes with χ2 test.
Results:
There were no differences between the two groups in terms of demographics, risk factors and comorbidities and preoperative features, except for the above cited characteristics. Also intraoperative features were similar in the two groups, with more than 85% of the interventions performed under clinical monitoring of the neurological status and about 95% of polyurethane patch angioplasty closures in both groups. Shunt insertion rate was significantly higher in group 1 (19.7%) than in group 2 (16%, p=0.03). Perioperative mortality was 0.3% in group 1 (3 patients) and 0.3% in group 2 (3 cases, p=0.7). At 30 days there were 7 neurological events in group 1 (0.8%) and 8 events in group 2 (0.7%, p=0.8), of which 6 and 5 were strokes, respectively. Thirty-day stroke and death rates were 1% in group 1 and 0.75% in group 2 (p=0.5). There w ere no differences between the two groups in terms of neck haematoma requiring surgical revision, of cranial nerve injuries and of perioperative myocardial infarction. Patients in group 1 experienced more frequently a perioperative atrial fibrillation (13 cases, 1.4%) than patients in group 2 (5 cases, 0.4%; p=0.02).
Conclusion:
Carotid endarterectomy performed in patients that should not undergo intervention on the basis of the recent guidelines provided excellent perioperative results, similar to those of patients inside the suggested indications. A long-term comparison is necessary.