Long-term Morbidity and Mortality of Carotid Endarterectomy in Patients with End-stage Renal Disease Receiving Hemodialysis

• Published in: Journal of stroke and cerebrovascular diseases 2014-03, Vol.23 (3), p.545-549
• Main Authors: Okawa, Masakazu, MD, Ueba, Tetsuya, MD, PhD, Ogata, Toshiyasu, MD, PhD, Abe, Hiroshi, MD, PhD, Higashi, Toshio, MD, PhD, Inoue, Tooru, MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cardiovascular; Carotid Artery Diseases - complications; Carotid Artery Diseases - diagnosis; Carotid Artery Diseases - mortality; Carotid Artery Diseases - surgery; carotid endarterectomy; Disability Evaluation; Endarterectomy, Carotid - adverse effects; Endarterectomy, Carotid - mortality; Female; Heart Failure - etiology; Hemodialysis; Humans; Japan; Kaplan-Meier Estimate; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - therapy; long-term follow-up; Male; Middle Aged; Myocardial Infarction - etiology; Neurology; Patient Selection; Renal Dialysis - adverse effects; Renal Dialysis - mortality; Retrospective Studies; Risk Assessment; Risk Factors; Sepsis - etiology; Stroke - etiology; Survivors; symptomatic; Time Factors; Treatment Outcome
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2013.05.012

Background and Purpose Renal insufficiency is a known risk factor for stroke. However, the impact of carotid endarterectomy (CEA) on stroke incidence in patients requiring dialysis remains controversial. We hypothesized that patients undergoing dialysis have no greater risk for periprocedural adverse events. Methods We performed a retrospective chart review of 12 CEA patients who were on dialysis at the time of CEA. The charts were reviewed for patient demographics, systemic vascular disease, perioperative morbidity and mortality rates, and long-term outcome. Outcomes were recorded in terms of modified Rankin Scale (mRS). Results The mean patient age at the time of CEA was 66.9 ± 7.3 years, with 1 patient having received carotid artery stenting for restenosis. Of the 12 patients undergoing 15 CEAs while being dialysis dependent, none exhibited periprocedural complications including stroke and myocardial infarction. During the follow-up period (mean, 56.1 ± 38.8 months), 3 patients had strokes unrelated to the target vessels for CEA, and 3 patients died from acute myocardial infarction, congestive heart failure, and sepsis. The calculated 5-year survival rate in our series was 58.3% in all cases, 40.0% in symptomatic patients, and 71.4% in asymptomatic patients. Eight patients (66.6%) had a good outcome. Conclusions These data suggest that patients undergoing dialysis were at no greater risk for periprocedural complications when undergoing CEA. Thus, CEA may be effective for stroke prevention in hemodialysis patients.