The Impact of Diabetes Mellitus on Outcomes Following Carotid Intervention for Asymptomatic Patients with >80% Stenosis

Diabetes mellitus (DM) has been suggested to increase operative risk during carotid intervention, but few studies have looked at outcomes based on stenosis. This study aims to study the effect of DM on outcomes after carotid artery stenting (CAS) or carotid endarterectomy (CEA) in asymptomatic patients with stenosis >80%. This was a retrospective study using the Vascular Quality Initiative dataset. Inclusion criteria are asymptomatic patients undergoing CAS or CEA with >80% stenosis based on preoperative imaging with the exposure variable, DM. Primary endpoints are perioperative stroke and mortality with secondary endpoints being long-term stroke, mortality, and reinterventions. A total of 53,187 patients underwent CAS, of whom 37.95% had DM. In the perioperative period, patients with DM undergoing CAS were more likely to have a new neurologic event (2.69% vs 2.2%; P ≤ .001; odds ratio [OR], 1.23; 95% confidence interval [CI], 1.1-1.38) and increased mortality (1.00% vs 0.72%; P = .001; OR, 1.38; 95% CI, 1.14-1.66), but were less likely to return to the operating room (Table). They were also more likely to develop myocardial infarction and congestive heart failure and require intravenous medications for hypertension. A total of 110,435 patients underwent CEA, of whom 36.01% had DM. Perioperatively, CEA patients with DM were more likely to have a new neurologic event (1.75% vs 1.37%; P ≤ .001; OR, 1.28; 95% CI, 1.16-1.41) but there was no significant increased mortality (0.41% vs 0.34%; P = .054; OR, 1.22; 95% CI, 0.996-1.48) (Fig). They were also more likely to return to the operating room, require intravenous medications for hypertension and develop myocardial infarction and congestive heart failure. Overall, there were no observed differences in long-term endpoints. Any differences between procedure groups were also observed in patients without DM. Patients with DM undergoing any carotid intervention have higher rates of perioperative stroke and CAS patients had increased mortality, though no differences in long-term outcomes. Intervention should be chosen based on individual patient characteristics with preoperative optimization.TablePerioperative and long-term outcomes of patients undergoing carotid artery stenting (CAS) and carotid endarterectomy (CEA) for asymptomatic stenosis >80% by diabetic statusCAS DM, n (%)20,183 (37.95)No DM, n (%)33,004 (62.05)P-valueCEA DM, n (%)39,766 (36.01)No DM, n (%)70,669 (63.99)P-valuePerioperative New neurologic event543 (2.69)726 (2.2)< .001695 (1.75)967 (1.37)< .001 Cranial nerve injury34 (0.17)50 (0.15).633896 (2.25)1630 (2.31).569 Hypertension2805 (13.9)4077 (12.35)< .0018690 (21.85)12,813 (18.13)< .001 Hypotension3540 (17.54)5834 (17.68).6874409 (11.09)8382 (11.86)< .001 Myocardial infarction157 (0.78)191 (0.58).006381 (0.96)440 (0.62)< .001 Dysrhythmia346 (1.71)538 (1.63).461730 (1.84)1189 (1.68).061 Congestive heart failure123 (0.61)115 (0.35)< .001257 (0.65)261 (0.37)< .001 Wound infection7 (0.03)11 (0.03).93425 (0.06)38 (0.05).543 Reperfusion symptoms104 (0.52)177 (0.54).74676 (0.19)122 (0.17).486 Return to operating room3504 (17.36)6088 (18.45).002831 (2.09)1327 (1.88).015 Mortality201 (1.00)239 (0.72).001164 (0.41)240 (0.34).054Long-term11,328 (38.0)18,505 (62.0)27,538 (36.04)48,881 (63.96) Mortality414 (3.65)664 (3.59).765739 (2.68)1375 (2.81).295 Neurologic event243 (2.15)406 (2.19).736583 (2.12)979 (2.00).325 Cranial nerve injury1 (0.01)2 (0.01).870126 (0.46)260 (0.53).150 Duplex stenosis0%-49%4903 (43.28)8067 (43.59).20815390 (55.89)27,419 (56.09).33450%-69%877 (7.74)1332 (7.20).0842312 (8.40)3950 (8.08).12170%-79%177 (1.56)311 (1.68).413406 (1.47)768 (1.57).29280%-99%82 (0.72)146 (0.79).515204 (0.74)366 (0.75).900Occluded52 (0.46)69 (0.37).262124 (0.45)214 (0.44).804Unknown73 (0.64)114 (0.62).7780 (0)0 (0)1.000 Reoperation5 (0.04)15 (0.08).11695 (0.34)189 (0.39).346DM, Diabetes mellitus.Boldface P values indicate statistical significance. Open table in a new tab