Impact of diabetes mellitus on characteristics of carotid plaques and outcomes after carotid endarterectomy

  • S. M
  • H. K
  • N. S
 et al. 
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Abstract

Background: Published results for carotid endarterectomy (CEA) in symptomatic and asymptomatic severe carotid stenosis with diabetes mellitus (DM) are contradictory. To evaluate perioperative and long-term results of CEA in patients with DM, we retrospectively analyzed data of patients with or without DM who underwent CEA in our institute. Methods: Between January 2005 and December 2010, 281 consecutive CEAs were performed in 268 patients under general anesthesia. All patients were subject to cardiac work-ups before surgery, and coronary revascularization was performed prior to CEA if patients were diagnosed with significant coronary artery stenosis. Lesion characteristics were assessed by a duplex ultrasound scan, computed tomography angiography (CTA), and plaque imaging on magnetic resonance imaging (MRI) before surgery, and patients were followed-up by a duplex ultrasound scan at three, six, and 12 months, then yearly, after surgery. Results: Of 281 cases, 136 had DM (48 %). Diabetic patients more frequently had a history of coronary artery disease than non-diabetic patients (48.5 % vs. 36.6 %, P = 0.042). Coronary intervention prior to CEA was more frequently performed in diabetic patients than in non-diabetic patients (22.1 % vs. 11.0 %, P = 0.013). The incidence of perioperative (30 day) stroke (P = 1.000), death (P = 1.000), and cardiac complications (P = 0.484) did not differ among groups. Follow-up was available in 77.2 % of patients, with a median duration of 50 months (interquartile range, 32.1-67.2 months). The incidence of ipsilateral stroke (P = 0.720), death (P = 0.351), and severe restenosis (peak systolic velocity > 230 cm/sec) (P = 0.905) were not different between groups. Conclusions: DM does not increase the risk of perioperative complications and does not influence long-term outcomes after CEA if preexisting vascular risk factors and cardiac diseases are appropriately evaluated and treated before surgery. © 2014 Springer-Verlag.

Author-supplied keywords

  • 80 and over
  • Aged
  • Anesthesia
  • Atherosclerotic
  • Carotid
  • Carotid Stenosis
  • Case-Control Studies
  • Comorbidity
  • Coronary Artery Disease
  • Diabetes Mellitus
  • Doppler
  • Duplex
  • Endarterectomy
  • Female
  • General
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Plaque
  • Postoperative Complications
  • Retrospective Studies
  • Risk Factors
  • Stroke
  • Treatment Outcome
  • Ultrasonography
  • aged
  • article
  • carotid artery obstruction
  • carotid endarterectomy
  • computed tomographic angiography
  • controlled study
  • coronary artery disease
  • coronary artery obstruction
  • diabetes mellitus
  • epidemiology
  • female
  • follow up
  • heart muscle revascularization
  • human
  • major clinical study
  • male
  • methods
  • morbidity
  • mortality
  • nuclear magnetic resonance imaging
  • priority journal
  • restenosis
  • surgery
  • ultrasonography
  • ultrasound

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Authors

  • Mizuhashi S.

  • Kataoka H.

  • Sano N.

  • Ideguchi M.

  • Higashi M.

  • Miyamoto Y.

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