BACKGROUND: Few studies have focused directly on carotid endarterectomy (CEA) in symptomatic and asymptomatic diabetic patients, reporting controversial outcome. We compared perioperative (30-day) and late outcomes in diabetic versus nondiabetic patients undergoing CEA for severe asymptomatic carotid disease. METHODS: Over 10 years, data were prospectively collected for diabetic and nondiabetic patients undergoing CEA for asymptomatic severe carotid disease. All procedures were eversion CEA. All patients underwent concomitant neurologic follow-up and a duplex ultrasound scan at 1, 6, and 12 months, then yearly, after operation. RESULTS: Of 391 CEAs performed on 374 patients, 112 (28.7%) were in diabetic patients. There were no perioperative deaths or strokes in either diabetic patients or nondiabetic patients. A significantly higher incidence of cardiac complications occurred in diabetic patients (P < .01). A complete follow-up (mean, 6.1 years) was obtained for 348 patients. No recurrent stenoses or late occlusions were diagnosed in diabetic or nondiabetic patients. At 10 years, the risk of death was up to 4.6 times higher in diabetic patients, with a significant prevalence of cardiac-related deaths (P < .01). CONCLUSIONS: CEA can be performed with no perioperative stroke risk or mortality, for asymptomatic disease in both diabetic and nondiabetic patients. The absence of fatal strokes associated with a significantly higher risk of cardiac-related death in the long-term points to the need to improve prevention strategies for postoperative cardiac risk in diabetic patients.
BACKGROUND: Few studies have focused directly on carotid endarterectomy (CEA) in symptomatic and asymptomatic diabeticpatients, reporting controversial outcome. We compared perioperative (30-day) and late outcomes in diabetic versus nondiabeticpatients undergoing CEA for severe asymptomatic carotid disease. METHODS: Over 10 years, data were prospectively collected for diabetic and nondiabeticpatients undergoing CEA for asymptomatic severe carotid disease. All procedures were eversion CEA. All patients underwent concomitant neurologic follow-up and a duplex ultrasound scan at 1, 6, and 12 months, then yearly, after operation. RESULTS: Of 391 CEAs performed on 374 patients, 112 (28.7%) were in diabeticpatients. There were no perioperative deaths or strokes in either diabeticpatients or nondiabeticpatients. A significantly higher incidence of cardiac complications occurred in diabeticpatients (P < .01). A complete follow-up (mean, 6.1 years) was obtained for 348 patients. No recurrent stenoses or late occlusions were diagnosed in diabetic or nondiabeticpatients. At 10 years, the risk of death was up to 4.6 times higher in diabeticpatients, with a significant prevalence of cardiac-related deaths (P < .01). CONCLUSIONS: CEA can be performed with no perioperative stroke risk or mortality, for asymptomatic disease in both diabetic and nondiabeticpatients. The absence of fatal strokes associated with a significantly higher risk of cardiac-related death in the long-term points to the need to improve prevention strategies for postoperative cardiac risk in diabeticpatients.