Eighty-two percent survived five years; high risk factor patients may not live to see benefit of CEA
Newswise — WASHINGTON, D.C.–While carotid endarterectomy (CEA) is performed to prevent stroke, long-term survival is essential to ensure benefit, especially in asymptomatic patients. A new study presented at the 66th Vascular Annual Meeting presented by the Society for Vascular Surgery® today examined patient factors associated with 5-year survival following CEA in patients with asymptomatic internal carotid artery (ICA) stenosis.
Between 2002-2011, vascular surgeons from the Vascular Study Group of New England (VSGNE) prospectively collected data from 4,294 isolated CEA’s performed for asymptomatic stenosis from the VSGNE’s 24 centers. Mortality was determined from the Social Security Death Index and Cox proportional hazard models were used to identify risk factors for mortality within the first five years after CEA.
Overall 5-year survival was 82 percent. Patients were classified as low (52 percent), medium (36 percent) and high risk (12 percent) based on number of risk factors had 5-year survival rates of 93 percent, 85 percent and 57 percent respectively (p<0.001). In multivariate analysis, increasing strata of age, diabetes, smoking history, congestive heart failure, chronic obstructive pulmonary disease, poor renal function (eGFR<60 or dialysis dependence), and degree of contralateral ICA were all associated with worse survival, however statin use predicted improved survival.
“More than four out of five asymptomatic patients selected for CEA in the VSGNE achieved 5-year survival, demonstrating appropriate patient selection in our region,” added co-author Jessica B. Wallaert, MD, and instructor of surgery from the Dartmouth Hitchcock Medical Center in Lebanon, N.H. “However, there are patients with high risk profiles, based on the above risk factors, who are unlikely to survive long enough to realize a benefit of CEA for asymptomatic stenosis. Predicting survival is important for decision- making in these patients.”
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About the Society for Vascular SurgeryThe Society for Vascular Surgery® (SVS) is a not-for-profit professional medical society, composed primarily of vascular surgeons, that seeks to advance excellence and innovation in vascular health through education, advocacy, research, and public awareness. SVS is the national advocate for 3,370 specialty-trained vascular surgeons and other medical professionals who are dedicated to the prevention and cure of vascular disease. Visit its Web site at www.VascularWeb.org® and follow SVS on Twitter by searching for VascularHealth or at http://twitter.com/VascularHealth.
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Journal of Vascular Surgery (June, 2012)