RISK FACTORS FOR PERI-OPERATIVE STROKE COMPLICATING CAROTID ENDARTERECTOMY: SELECTIVE ANALYSIS OF A PROSPECTIVE AUDIT OF 1000 CONSECUTIVE OPERATIONS

Background: The aim of the present study was to investigate the role of potential clinical risk factors in the causation of peri‐operative stroke associated with carotid endarterectomy. With the change in carotid endarterectomy practice from the use of a shunt to high‐dose thiopental for cerebral pr...

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Bibliographic Details
Published in:Australian and New Zealand Journal of Surgery 2000-01, Vol.70 (1), p.52-56
Main Authors: Frawley, J. E., Hicks, R. G.
Format: Article
Language:English
Subjects:
Age Factors
Aged
Anesthetics, Intravenous - administration & dosage
carotid endarterectomy
Carotid Stenosis - surgery
Endarterectomy, Carotid - adverse effects
Endarterectomy, Carotid - methods
Female
Humans
Hypertension - complications
Male
Medical Audit
Postoperative Period
prospective audit
Prospective Studies
Risk Factors
Sex Factors
Stroke - epidemiology
Stroke - etiology
Thiopental - administration & dosage
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Summary:Background: The aim of the present study was to investigate the role of potential clinical risk factors in the causation of peri‐operative stroke associated with carotid endarterectomy. With the change in carotid endarterectomy practice from the use of a shunt to high‐dose thiopental for cerebral protection (a previously undocumented method), it was essential to identify accurately the causes of all peri‐operative strokes. Methods: A prospective audit was undertaken of 1000 carotid endarterectomies in which the causes and pathology of all peri‐operative strokes were documented. The roles of advanced age, female gender, hypertension, previous stroke, contralateral carotid stenosis > 70%, and contralateral carotid occlusion as potential causes of peri‐operative stroke were defined. Results were statistically analysed using odds ratio and Fisher’s exact test. Results: None of the potential risk factors was statistically significant for peri‐operative stroke. Female gender was associated with a significant risk of peri‐operative stroke due to operative site thrombosis. Complications at the endarterectomy site were the commonest cause of stroke. Conclusions: Prospective audit is a useful tool for identifying causes of peri‐operative stroke and indicating the need for modifications to surgical clinical management which might improve outcomes for carotid endarterectomy.
ISSN:0004-8682
1445-2197
DOI:10.1046/j.1440-1622.2000.01743.x