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Thirty six published studies fulfilled our criteria.The effect of 14 potential risk factors was examined.The odds of stroke and death were decreased in patients with ocular ischemia alone(amaurosis fugax or retinal artery occlusion)compared with those with cerebral transient ischemic attack or stroke(seven studies;odds ratio 0.49;95%confidence interval 0.37 to 0.66;P<0.00001).The odds were increased in women(seven studies;1.44;1.14 to 1.83;P<0.005),subjects aged>/=75 years(10 studies;1. 36;1.09 to 1.71;P<0.01),and with systolic blood pressure>180 mmHg(four studies;1.82;1.37 to 2.41 P<0.0001),peripheral vascular disease(one study; 2.19;1.40 to 3.60 P<0.0005),occlusion of the contralateral internal carotid artery(14 studies;1.91;1.35 to 2.69;P<0.0001),stenosis of the ipsilateral internal carotid siphon(five studies;1.61;1.05 to 2.47;P=0. 03).Operative risk was not significantly related to presentation with cerebral transient ischemic attack versus stroke,diabetes,angina,recent myocardial infarction,current cigarette smoking or plaque surface irregularity at angiography.Multiple regression analysis of data from the European carotid surgery trail identified cerebral versus ocular events at presentation,female sex,systolic hypertension and peripheral vascular disease as independent risk factors.The risk of stroke and death from carotid endarterectomy is related to several clinical and angiographic characteristics.These observations may help clinicians to estimate operative risks for individual patients and will also facilitate more meaningful comparison of the operative risks of different surgeons or at different institutions by allowing some adjustment for differences in case mix. |
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carotid angiogram
carotid artery stenosis,contralateral occlusion with
carotid siphon
carotid-siphon occlusion
cerebrovascular accident
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cerebrovascular accident,women
endarterectomy,carotid
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endarterectomy,carotid-contralateral carotid occlusion-stenosis
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