Diabetes and asymptomatic carotid stenosis: Does diabetic disease influence the outcome of carotid endarterectomy? A 10-year single center experience

• Published in: Surgery Vol. 143; no. 4; pp. 519 - 525
• Main Authors: Ballotta, Enzo, MD, Manara, Renzo, MD, Meneghetti, Giorgio, MD, Ermani, Mario, MD, Da Giau, Giuseppe, MD, Baracchini, Claudio, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.04.2008; Elsevier
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Carotid Stenosis - complications; Carotid Stenosis - surgery; Diabetes Complications - complications; Diabetes. Impaired glucose tolerance; Endarterectomy, Carotid - adverse effects; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; General aspects; Humans; Male; Medical sciences; Middle Aged; Postoperative Complications - etiology; Surgery; Treatment Outcome; Endocrinopathy; Carotid stenosis; Nervous system diseases; Center; Prognosis; Disease; Diabetes mellitus; Cardiovascular disease; Asymptomatic; Cerebral disorder; Arterial disease; Vascular disease; Medicine; Treatment; Carotid; Surgery; Central nervous system disease; Evolution; Endarteriectomy; Cerebrovascular disease
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2007.10.012

Background Few studies have focused directly on carotid endarterectomy (CEA) in symptomatic and asymptomatic diabetic patients, reporting controversial outcome. We compared perioperative (30-day) and late outcomes in diabetic versus nondiabetic patients undergoing CEA for severe asymptomatic carotid disease. Methods Over 10 years, data were prospectively collected for diabetic and nondiabetic patients undergoing CEA for asymptomatic severe carotid disease. All procedures were eversion CEA. All patients underwent concomitant neurologic follow-up and a duplex ultrasound scan at 1, 6, and 12 months, then yearly, after operation. Results Of 391 CEAs performed on 374 patients, 112 (28.7%) were in diabetic patients. There were no perioperative deaths or strokes in either diabetic patients or nondiabetic patients. A significantly higher incidence of cardiac complications occurred in diabetic patients ( P < .01). A complete follow-up (mean, 6.1 years) was obtained for 348 patients. No recurrent stenoses or late occlusions were diagnosed in diabetic or nondiabetic patients. At 10 years, the risk of death was up to 4.6 times higher in diabetic patients, with a significant prevalence of cardiac-related deaths ( P < .01). Conclusions CEA can be performed with no perioperative stroke risk or mortality, for asymptomatic disease in both diabetic and nondiabetic patients. The absence of fatal strokes associated with a significantly higher risk of cardiac-related death in the long-term points to the need to improve prevention strategies for postoperative cardiac risk in diabetic patients.