The association between preoperative clinical risk factors and in-hospital strokes and death following carotid endarterectomy in South African patients

Abstract

Background: Current surgical management of carotid artery disease includes carotid endarterectomy (CEA). In-hospital strokes and death following CEA might be associated with preinduction blood pressure (BP) measurements and other clinical risk factors.

Method: The aim of our study was to determine whether or not there is an association between preinduction BP, other clinical risk factors, and in-hospital strokes or death following CEA in a cohort of South African patients. We collected data from medical records relating to clinical risk factors in patients, preinduction BP measurements, and in-hospital strokes and death, following CEA. The association between preinduction BP and clinical risk factors, and postoperative neurological morbidity and mortality, was analysed using univariate statistical methods.

Results: Our cohort consisted of 76 patients who underwent CEA. Eight of these patients had in-hospital strokes or death following their surgery. An association between a history of hypertension or other clinical risk factors and an in-hospital stroke and death was not identified in these 76 CEA patients following univariate analysis. However, patients with preinduction BP within the lowest or highest quartile for preinduction BP were at a significantly increased risk of an in-hospital stroke and death following their surgery (p-value = 0.003). A subanalysis of patients who were hypertensive also showed this univariate association (p-value = 0.003).

Conclusion: It is possible that extremes of preinduction BP might be associated with in-hospital strokes and death in CEA patients following their surgery, although further research is required to confirm this.

Keywords: carotid endarterectomy, carotid stenosis, mortality, strokes, surgery