Clinical research
Interaction of cerebrovascular disease and contralateral carotid occlusion in prediction of shunt insertion during carotid endarterectomy
Interaction of cerebrovascular disease and contralateral carotid occlusion in prediction of shunt insertion during carotid endarterectomy
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Submission date: 2011-03-11
Final revision date: 2011-05-15
Acceptance date: 2011-07-24
Online publication date: 2012-05-09
Publication date: 2012-04-30
Arch Med Sci 2012;8(2):236–243
KEYWORDS
TOPICS
ABSTRACT
Introduction: To assess the possible role and the interaction of cerebrovascular disease and vascular stenosis on the necessity of shunt insertion during carotid endarterectomy (CEA).
Material and methods: Eighty consecutive patients undergoing CEA under regional anaesthesia were prospectively enrolled. Patients were divided into two groups depending on whether they were shunted or not. The measured end-points were co-morbidities degree of contralateral and carotid stenosis and other intra- and postoperative outstanding parameters. ANOVA, Student’s t and 2 tests were used (p < 0.05). Variables differing significantly between groups and potential confounders were used in backward stepwise logistic regression to estimate the relative risk (RR, 95% CI) of shunt. In addition Wald’s test (p < 0.05) with and without adjustments for potential confounders was used with various different multivariate analysis models.
Results: Contralateral stenosis and cerebral vascular accidents (CVA) were more frequently observed in shunted patients. The RR for patients with contralateral stenosis 50% was 1.3 (95% CI 1.0-1.5) and for patients with previous CVA was 1.2 (95% CI 1.0-1.4). For contralateral stenosis and CVA together the RR increased to 7.7 (95% CI 1.0-14.4). A model based on contralateral stenosis and CVA was found to be statistically significant (p = 0.003) for shunt (RR = 1.1, 95% CI 1.0-2.1). Relative excess risk due to interaction of both factors was 6.2.
Conclusions: The findings suggest that patients with contralateral stenosis 50% and previous CVA have a higher risk of requiring shunt use during CEA than patients with these risk factors separately.
Material and methods: Eighty consecutive patients undergoing CEA under regional anaesthesia were prospectively enrolled. Patients were divided into two groups depending on whether they were shunted or not. The measured end-points were co-morbidities degree of contralateral and carotid stenosis and other intra- and postoperative outstanding parameters. ANOVA, Student’s t and 2 tests were used (p < 0.05). Variables differing significantly between groups and potential confounders were used in backward stepwise logistic regression to estimate the relative risk (RR, 95% CI) of shunt. In addition Wald’s test (p < 0.05) with and without adjustments for potential confounders was used with various different multivariate analysis models.
Results: Contralateral stenosis and cerebral vascular accidents (CVA) were more frequently observed in shunted patients. The RR for patients with contralateral stenosis 50% was 1.3 (95% CI 1.0-1.5) and for patients with previous CVA was 1.2 (95% CI 1.0-1.4). For contralateral stenosis and CVA together the RR increased to 7.7 (95% CI 1.0-14.4). A model based on contralateral stenosis and CVA was found to be statistically significant (p = 0.003) for shunt (RR = 1.1, 95% CI 1.0-2.1). Relative excess risk due to interaction of both factors was 6.2.
Conclusions: The findings suggest that patients with contralateral stenosis 50% and previous CVA have a higher risk of requiring shunt use during CEA than patients with these risk factors separately.
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