Carotid endarterectomy at the millennium: What interventional therapy must match

Glenn M. LaMuraglia, David C. Brewster, Ashby C. Moncure, David J. Dorer, Michael C. Stoner, Samir K. Trehan, Elizabeth C. Drummond, William M. Abbott, Richard P. Cambria, Julie Ann Freischlag, Norman M. Rich, Christopher K. Zarins

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

Objectives: Carotid endarterectomy (CEA) is supported by level 1 evidence as the standard treatment of severe carotid stenosis in both symptomatic and asymptomatic patients. As interventional techniques are emerging for treatment of this disease, this study was undertaken to provide a contemporary surgical standard for comparison to carotid stenting. Patients and methods: During the interval 1989 to 1999, 2236 isolated CEAs were performed on 1897 patients (62% male, 36% symptomatic, 4.6% reoperative procedures). Study endpoints included perioperative events, patient survival, late incidence of stroke, anatomic durability of CEA, and resource utilization changes during the study. Variables associated with complications, long-term and stroke free survival, restenosis, and resource utilization were analyzed by univariate and multivariate analysis. Results: Perioperative complications occurred in 5.5% of CEA procedures, including any stroke/death (1.4%), neck hematoma (1.7%), cardiac complications (0.5%), and cranial nerve injury (0.4%). Actuarial survival at 5 and 10 years was 72.4% (95% confidence interval [CI] 69.3-73.5) and 44.7% (95% CI 41.7-47.9) respectively, with coronary artery disease (P < 0.0018), chronic obstructive pulmonary disease (P < 0.00018) and diabetes mellitus (P < 0.0011) correlating with decreased longevity. The age- and sex-adjusted incidence of any stroke during follow-up was reduced by 22% (upper 0.35, lower 0.08) of predicted with the patient classification of hyperlipidemia (P < 0.0045) as the only protective factor. Analysis of CEA anatomic durability during a median follow-up period of 5.9 years identified a 7.7% failure rate (severe restenosis/occlusion, 4.5%; or reoperative CEA, 3.2%) with elevated serum cholesterol (P < 0.017) correlating with early restenosis. Resource utilization diminished (first versus last 2-year interval periods) for average hospital length of stay from 10.3 ± 1.5 days to 4.3 ± 0.7 days (P < 0.01) and preoperative contrast angiography from 87% ± 1.4% to 10.3% ± 4%. Conclusions: These data delineate the safety, durability, and effectiveness in long-term stroke prevention of CEA. They provide a standard to which emerging catheter-based therapies for carotid stenosis should be compared.

Original languageEnglish (US)
Pages (from-to)535-546
Number of pages12
JournalAnnals of Surgery
Volume240
Issue number3
DOIs
StatePublished - Sep 2004
Externally publishedYes

Fingerprint

Carotid Endarterectomy
Stroke
Carotid Stenosis
Survival
Length of Stay
Cranial Nerve Injuries
Therapeutics
Confidence Intervals
Incidence
Hypercholesterolemia
Hyperlipidemias
Hematoma
Chronic Obstructive Pulmonary Disease
Coronary Artery Disease
Diabetes Mellitus
Angiography
Neck
Multivariate Analysis
Catheters
Safety

ASJC Scopus subject areas

  • Surgery

Cite this

LaMuraglia, G. M., Brewster, D. C., Moncure, A. C., Dorer, D. J., Stoner, M. C., Trehan, S. K., ... Zarins, C. K. (2004). Carotid endarterectomy at the millennium: What interventional therapy must match. Annals of Surgery, 240(3), 535-546. https://doi.org/10.1097/01.sla.0000137142.26925.3c

Carotid endarterectomy at the millennium : What interventional therapy must match. / LaMuraglia, Glenn M.; Brewster, David C.; Moncure, Ashby C.; Dorer, David J.; Stoner, Michael C.; Trehan, Samir K.; Drummond, Elizabeth C.; Abbott, William M.; Cambria, Richard P.; Freischlag, Julie Ann; Rich, Norman M.; Zarins, Christopher K.

In: Annals of Surgery, Vol. 240, No. 3, 09.2004, p. 535-546.

Research output: Contribution to journalArticle

LaMuraglia, GM, Brewster, DC, Moncure, AC, Dorer, DJ, Stoner, MC, Trehan, SK, Drummond, EC, Abbott, WM, Cambria, RP, Freischlag, JA, Rich, NM & Zarins, CK 2004, 'Carotid endarterectomy at the millennium: What interventional therapy must match', Annals of Surgery, vol. 240, no. 3, pp. 535-546. https://doi.org/10.1097/01.sla.0000137142.26925.3c
LaMuraglia GM, Brewster DC, Moncure AC, Dorer DJ, Stoner MC, Trehan SK et al. Carotid endarterectomy at the millennium: What interventional therapy must match. Annals of Surgery. 2004 Sep;240(3):535-546. https://doi.org/10.1097/01.sla.0000137142.26925.3c
LaMuraglia, Glenn M. ; Brewster, David C. ; Moncure, Ashby C. ; Dorer, David J. ; Stoner, Michael C. ; Trehan, Samir K. ; Drummond, Elizabeth C. ; Abbott, William M. ; Cambria, Richard P. ; Freischlag, Julie Ann ; Rich, Norman M. ; Zarins, Christopher K. / Carotid endarterectomy at the millennium : What interventional therapy must match. In: Annals of Surgery. 2004 ; Vol. 240, No. 3. pp. 535-546.
@article{7fe84f031ed541a789784a5701813343,
title = "Carotid endarterectomy at the millennium: What interventional therapy must match",
abstract = "Objectives: Carotid endarterectomy (CEA) is supported by level 1 evidence as the standard treatment of severe carotid stenosis in both symptomatic and asymptomatic patients. As interventional techniques are emerging for treatment of this disease, this study was undertaken to provide a contemporary surgical standard for comparison to carotid stenting. Patients and methods: During the interval 1989 to 1999, 2236 isolated CEAs were performed on 1897 patients (62{\%} male, 36{\%} symptomatic, 4.6{\%} reoperative procedures). Study endpoints included perioperative events, patient survival, late incidence of stroke, anatomic durability of CEA, and resource utilization changes during the study. Variables associated with complications, long-term and stroke free survival, restenosis, and resource utilization were analyzed by univariate and multivariate analysis. Results: Perioperative complications occurred in 5.5{\%} of CEA procedures, including any stroke/death (1.4{\%}), neck hematoma (1.7{\%}), cardiac complications (0.5{\%}), and cranial nerve injury (0.4{\%}). Actuarial survival at 5 and 10 years was 72.4{\%} (95{\%} confidence interval [CI] 69.3-73.5) and 44.7{\%} (95{\%} CI 41.7-47.9) respectively, with coronary artery disease (P < 0.0018), chronic obstructive pulmonary disease (P < 0.00018) and diabetes mellitus (P < 0.0011) correlating with decreased longevity. The age- and sex-adjusted incidence of any stroke during follow-up was reduced by 22{\%} (upper 0.35, lower 0.08) of predicted with the patient classification of hyperlipidemia (P < 0.0045) as the only protective factor. Analysis of CEA anatomic durability during a median follow-up period of 5.9 years identified a 7.7{\%} failure rate (severe restenosis/occlusion, 4.5{\%}; or reoperative CEA, 3.2{\%}) with elevated serum cholesterol (P < 0.017) correlating with early restenosis. Resource utilization diminished (first versus last 2-year interval periods) for average hospital length of stay from 10.3 ± 1.5 days to 4.3 ± 0.7 days (P < 0.01) and preoperative contrast angiography from 87{\%} ± 1.4{\%} to 10.3{\%} ± 4{\%}. Conclusions: These data delineate the safety, durability, and effectiveness in long-term stroke prevention of CEA. They provide a standard to which emerging catheter-based therapies for carotid stenosis should be compared.",
author = "LaMuraglia, {Glenn M.} and Brewster, {David C.} and Moncure, {Ashby C.} and Dorer, {David J.} and Stoner, {Michael C.} and Trehan, {Samir K.} and Drummond, {Elizabeth C.} and Abbott, {William M.} and Cambria, {Richard P.} and Freischlag, {Julie Ann} and Rich, {Norman M.} and Zarins, {Christopher K.}",
year = "2004",
month = "9",
doi = "10.1097/01.sla.0000137142.26925.3c",
language = "English (US)",
volume = "240",
pages = "535--546",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Carotid endarterectomy at the millennium

T2 - What interventional therapy must match

AU - LaMuraglia, Glenn M.

AU - Brewster, David C.

AU - Moncure, Ashby C.

AU - Dorer, David J.

AU - Stoner, Michael C.

AU - Trehan, Samir K.

AU - Drummond, Elizabeth C.

AU - Abbott, William M.

AU - Cambria, Richard P.

AU - Freischlag, Julie Ann

AU - Rich, Norman M.

AU - Zarins, Christopher K.

PY - 2004/9

Y1 - 2004/9

N2 - Objectives: Carotid endarterectomy (CEA) is supported by level 1 evidence as the standard treatment of severe carotid stenosis in both symptomatic and asymptomatic patients. As interventional techniques are emerging for treatment of this disease, this study was undertaken to provide a contemporary surgical standard for comparison to carotid stenting. Patients and methods: During the interval 1989 to 1999, 2236 isolated CEAs were performed on 1897 patients (62% male, 36% symptomatic, 4.6% reoperative procedures). Study endpoints included perioperative events, patient survival, late incidence of stroke, anatomic durability of CEA, and resource utilization changes during the study. Variables associated with complications, long-term and stroke free survival, restenosis, and resource utilization were analyzed by univariate and multivariate analysis. Results: Perioperative complications occurred in 5.5% of CEA procedures, including any stroke/death (1.4%), neck hematoma (1.7%), cardiac complications (0.5%), and cranial nerve injury (0.4%). Actuarial survival at 5 and 10 years was 72.4% (95% confidence interval [CI] 69.3-73.5) and 44.7% (95% CI 41.7-47.9) respectively, with coronary artery disease (P < 0.0018), chronic obstructive pulmonary disease (P < 0.00018) and diabetes mellitus (P < 0.0011) correlating with decreased longevity. The age- and sex-adjusted incidence of any stroke during follow-up was reduced by 22% (upper 0.35, lower 0.08) of predicted with the patient classification of hyperlipidemia (P < 0.0045) as the only protective factor. Analysis of CEA anatomic durability during a median follow-up period of 5.9 years identified a 7.7% failure rate (severe restenosis/occlusion, 4.5%; or reoperative CEA, 3.2%) with elevated serum cholesterol (P < 0.017) correlating with early restenosis. Resource utilization diminished (first versus last 2-year interval periods) for average hospital length of stay from 10.3 ± 1.5 days to 4.3 ± 0.7 days (P < 0.01) and preoperative contrast angiography from 87% ± 1.4% to 10.3% ± 4%. Conclusions: These data delineate the safety, durability, and effectiveness in long-term stroke prevention of CEA. They provide a standard to which emerging catheter-based therapies for carotid stenosis should be compared.

AB - Objectives: Carotid endarterectomy (CEA) is supported by level 1 evidence as the standard treatment of severe carotid stenosis in both symptomatic and asymptomatic patients. As interventional techniques are emerging for treatment of this disease, this study was undertaken to provide a contemporary surgical standard for comparison to carotid stenting. Patients and methods: During the interval 1989 to 1999, 2236 isolated CEAs were performed on 1897 patients (62% male, 36% symptomatic, 4.6% reoperative procedures). Study endpoints included perioperative events, patient survival, late incidence of stroke, anatomic durability of CEA, and resource utilization changes during the study. Variables associated with complications, long-term and stroke free survival, restenosis, and resource utilization were analyzed by univariate and multivariate analysis. Results: Perioperative complications occurred in 5.5% of CEA procedures, including any stroke/death (1.4%), neck hematoma (1.7%), cardiac complications (0.5%), and cranial nerve injury (0.4%). Actuarial survival at 5 and 10 years was 72.4% (95% confidence interval [CI] 69.3-73.5) and 44.7% (95% CI 41.7-47.9) respectively, with coronary artery disease (P < 0.0018), chronic obstructive pulmonary disease (P < 0.00018) and diabetes mellitus (P < 0.0011) correlating with decreased longevity. The age- and sex-adjusted incidence of any stroke during follow-up was reduced by 22% (upper 0.35, lower 0.08) of predicted with the patient classification of hyperlipidemia (P < 0.0045) as the only protective factor. Analysis of CEA anatomic durability during a median follow-up period of 5.9 years identified a 7.7% failure rate (severe restenosis/occlusion, 4.5%; or reoperative CEA, 3.2%) with elevated serum cholesterol (P < 0.017) correlating with early restenosis. Resource utilization diminished (first versus last 2-year interval periods) for average hospital length of stay from 10.3 ± 1.5 days to 4.3 ± 0.7 days (P < 0.01) and preoperative contrast angiography from 87% ± 1.4% to 10.3% ± 4%. Conclusions: These data delineate the safety, durability, and effectiveness in long-term stroke prevention of CEA. They provide a standard to which emerging catheter-based therapies for carotid stenosis should be compared.

UR - http://www.scopus.com/inward/record.url?scp=4344642730&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=4344642730&partnerID=8YFLogxK

U2 - 10.1097/01.sla.0000137142.26925.3c

DO - 10.1097/01.sla.0000137142.26925.3c

M3 - Article

C2 - 15319725

AN - SCOPUS:4344642730

VL - 240

SP - 535

EP - 546

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 3

ER -