Carotid Endarterectomy in Asymptomatic Patients With Limited Life Expectancy

Wallaert JB, De Martino RR, Finlayson SRG, et al (Dartmouth-Hitchcock Med Ctr, Lebanon NH; et al) Stroke 43:1781-1787, 2012^§

Abstract

Background and Purpose

Data from randomized trials assert that asymptomatic patients undergoing carotid endarterectomy (CEA) must live 3 to 5 years to realize the benefit of surgery. We examined how commonly CEA is performed among asymptomatic patients with limited life expectancy.

Methods

Within the American College of Surgeons National Quality Improvement Project we identified 8 conditions associated with limited life expectancy based on survival estimates using external sources. We then compared rates of 30-day stroke, death, and myocardial infarction after CEA between asymptomatic patients with and without life-limiting conditions.

Results

Of 12 631 CEAs performed in asymptomatic patients, 2525 (20.0%) were in patients with life-limiting conditions or diagnoses. The most common conditions were severe chronic obstructive pulmonary disease and American Society of Anesthesiologists Class IV designation. Patients with life-limiting conditions had significantly higher rates of perioperative complications, including stroke (1.8% versus 0.9%, P < 0.001), death (1.4% versus 0.3%, P < 0.001), and stroke/death (2.9% versus 1.1%, P < 0.001). Even after adjustment for other comorbidities, patients with life-limiting conditions were nearly 3 times more likely to experience perioperative stroke or death than those without these conditions (OR, 2.8; 95% CI, 2.1–3.8; P < 0.001).

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