Risk Factors Associated with Ipsilateral Ischemic Events Following Carotid Endarterectomy for Carotid Artery Stenosis

Objective: Patients undergoing carotid endarterectomy (CEA) are at risk of developing ipsilateral stroke or transient ischemic attacks (TIAs). In this study, we explored factors associated with development of these events following CEA in patients with long-term follow-up.

Methods: We performed a retrospective analysis of all neurosurgical patients who underwent CEA and presented with ipsilateral ischemic stroke, TIA, or amaurosis fugax. Factors were compared against the outcome variable in univariate analysis. Multivariate logistic regression model was used to identify independent predictive variables. We used Kaplan-Meier analysis (log-rank test) to compare the effect of variables on long-term event-free survival.

Results: Our study included 270 patients with an average age of 67.2 years. Two-hundred and forty-nine patients within our study cohort (92.2%) with 273 CEAs were followed at our institution. At presentation, 187 patients (68.5%) were symptomatic. The average follow-up was 50.2 months (113.2 lesion-years). Event-free survival was 91.6% and 89.9% at 2 years and 5 years, respectively. Family history of stroke (P = 0.002), cigarette smoking (P = 0.021), and atrial fibrillation (P = 0.005) significantly increased the risk of adverse events, whereas symptomatic presentation demonstrated a trend toward significance (P = 0.057). A higher risk for ischemic events was observed in female patients as compared with males with asymptomatic presentation (P = 0.005).

Conclusions: Our data suggest that family history of stroke, cigarette smoking, and atrial fibrillation are independent risk factors for developing ischemic events after CEA. In patients with asymptomatic presentation, female gender is also a risk factor. Identification of patients at risk is critical for tailored postoperative patient management and patient education.