Carotid Endarterectomy In Diabetic Patients: Are The Results Worth The Effort?

To evaluate results of carotid endarterectomy (CEA) in diabetic patients in a large single center experience Over a 13-year period ending in December 2008, 4304 consecutive CEAs were performed. Interventions were performed in diabetic patients in 882 cases (20.5%, Group 1) and in non diabetics in the remaining 3422 (79.5%, Group 2). Early results in terms of 30-day stroke and death rates were analyzed and compared. Follow-up results were analyzed with Kaplan Meyer curves and compared with log-rank test. There were no differences between the two groups in terms of preoperative clinical status or degree of carotid stenosis on the operated side. Combined 30-day stroke and death rate was significantly higher in group 1 (2%) than in group 2 (0.9%; p = 0.006). At univariate analysis, perioperative risk of stroke and death in diabetic patients was significantly impaired by the use of instrumental cerebral monitoring in comparison with clinical one (95% CI 0.9-39.9, OR 5.9, p = 0.01), and this was also at multivariate analysis (95% CI 1.1-23.1, OR 8.3, p = 0.04). Follow-up was available in 96.5% of patients with a mean duration of 40 months (range 1-166). There were no differences between the two groups in terms of estimated 7-year survival and stroke-free survival. Diabetic patients had poorer 7-year severe (>70%) restenosis-free survival rates than non diabetics (77.4% and 82.2%, respectively; p = 0.05). In our experience the presence of diabetes mellitus twofold increases perioperative risk of CEA, which however remains largely below the recommended standards. During follow-up this differences becomes negligible. In diabetics, cerebral clinical monitoring may be preferred whenever possible.