The influence of the state of the vertebral arteries on the peri- and postoperative risk in carotid surgery.

Abstract

To assess the significance of the vertebral arteries (VA) as a prognostic factor within the framework of carotid surgery. Prospective observational study. A total of 1338 operations were performed on 1182 patients. Three hundred and six of the patients had angiographically confirmed unilateral (299) or bilateral (seven) involvement of the VA. In 31 cases it was not possible to assess the VA. Life table analysis. Thirty-day mortality rate was 1.6% (21 out of 1338) for all reconstructions of the internal carotid artery. In addition to three fatal strokes, 22 hemispheric events were noted (1.6%, 22/1338). Follow-up varied between 1 and 96 months (mean 34, S.E.M. 0.76, median 29) and covered a total of 3361 patient years. The cumulative 5-year survival rate was 69%. Irrespective of age, cardiac events were the leading cause of death. In patients with VA involvement, both the 30-day stroke and mortality rate (p < 0.01) and the long-term survival rate (p < 0.01) were significantly poorer. Concomitant vertebral artery disease increases the morbidity and mortality of carotid surgery, presumably due to reduced collateral perfusion during cross-clamping. However, the overall risk of surgery remains acceptable.