Objective To investigate the causes of death after carotid endarterectomy(CEA).
Methods Three hundred and two patients who underwent CEA for carotid artery stenosis in Xuanwu Hospital from January 2001 to September 2011 were retrospectively analyzed(6 of them underwent bilateral operation at two different stages, each patient was calculated as 2; therefore there were a total of 308 patients). We statistically analyzed the number of those patients who died after CEA and their causes of death. Those patients were divided into two groups: survival group and death group. The following data, including gender, age, past history, previous stroke, transient ischemic attack(TIA), modified Rankin Scale(mRS), the influence of complications after surgery on death, were compared.
Results There was significant difference in smoking between death group and survival group(100% vs 32.9%, P=0.013). There were no significant differences in the constituent ratios of gender(male) and age more than 70 years old between both groups(100% vs 89.8%, 25.0% vs 25.7%). There were no significant differences between both groups in those risk factors, such as TIA, cerebral infarction, hypertension, diabetes mellitus, hyperlipemia and coronary heart diseases. There were no significant differences in patients without symptoms and in patients with mRS3 between both groups. There were significant differences in postoperative cerebral hemorrhage between both groups(50.0% vs 2.0%, P=0.003; 50.0% vs 6.9%, P=0.029). There were no significant differences in shunting, the number of embolus 20(monitored by transcranial Doppler[TCD]), cardiac complications, postoperative cerebral infarction between both groups.
Conclusions A higher mortality is found in those patients who underwent CEA with smoking history, postoperative cerebral hemorrhage and subcutaneous hematoma. The key measures to reduce the mortality are careful evaluation before the surgery, progressive prevention against postoperative cerebral hemorrhage and subcutaneous hematoma.
