Impact of intraoperative neurologic deficits in carotid endarterectomy under regional anesthesia

Figures & data

Table 1. Population demographics and comorbidities.

Variables	Control n = 85 (%)	IND n = 79 (%)	p Value	Multivariable
Sex (female)	14 (16)	19 (24)	.226
Age (mean ± SD)	68 ± 9.0	71 ± 9.30	.042	NC
Age ≥ 75	22 (26)	34 (4.0)	.021
Cardiovascular risk factors
Hypertension	73 (86)	73 (92)	.182
Diabetes	33 (39)	37 (47)	.300
Dyslipidemia	73 (86)	67 (86)	.998
Smoking	40 (47)	44 (56)	.269
BMI > 30 kg/m^2	4 (5)	19 (24)	.0001	aOR: 9.30 95% CI: 2.57–33.69; p=.001
CKD	9 (11)	9 (11)	.869
COPD	7 (8)	9 (11)	.496
CAD	30 (35)	35 (44)	.239
PAD	23 (27)	20 (25)	.800
CHF	12 (14)	14 (18)	.549
Anti-hypertensive agents (n) (mean ± SD)	2 ± 1.28	2 ± 1.05	.347
Anti-hypertensive agents
ACEI	62 (75)	61 (77)	.708
Beta-blocker	26 (31)	26 (33)	.829
CCB	25 (30)	38 (48)	.019	NC
Thiazide diuretics	36 (43)	31 (39)	.593
Nitrate	4 (5)	9 (11)	.124	NC
Hb (g/dL) (mean ± SD)	12.8 ± 2.08	13.2 ± 1.8	.219
ASA (I–V) (mean ± SD)	2.79 ± 0.514	2.96 ± 0.406	.017	NC

ACEI: angiotensin-converting enzyme inhibitor; aOR: adjusted odds ratio; ASA: American Society of Anesthesiologists Physical Status Classification System; CAD: coronary artery disease; CCB: calcium channel blocker; CHF: chronic heart failure; 95% CI: confidence interval 5–95%; CKD: chronic kidney disease (creatinine = 1.5 mg/dL); COPD: chronic obstructive pulmonary disease; Hb: hemoglobin; PAD: peripheral artery disease; BMI: body mass index; NC: not confirmed on multivariable analysis; IND: alterations on the neurologic examination during carotid clamping.

Table 2. Intraoperative and neurovascular predictors.

Variables	Control n = 85 (%)	IND n = 79 (%)	p Value	Multivariable
Asymptomatic	46 (54)	47 (60)
Symptomatic	39 (46)	32 (40.5)	.488
TIA	11 (13)	6 (87.6)
Stroke	28 (33)	26 (33)
Time to revascularization (days) (median) (IQR)	17.5 [10.25–57.75]	13.5 [10–39.25]	.795
NIHSS (n = 39) (mean ± SD)	6 ± 5.891	8 ± 6.134	.493
NIHSS > 10	4 (10)	6 (19)	.426
Side (left)	41 (48)	49 (6.0)	.076	NC
Stenosis degree (mean ± SD)	86 ± 9.54	82.5 ± 10.78	.031	aOR: 0.70, 95% CI: 0.49–0.99; p=.047
Contralateral stenosis (mean ± SD)	61.7 ± 17.02	68.9 ± 22.9	.026	aOR: 1.30, 95% CI: 1.06–1.50; p=.009
Vertebrobasilar disease	13 (16)	17 (22)	.353
Surgery time (min) (mean ± SD)	117 ± 55.2	111 ± 28.0	.408
Clamping time (min) (mean ± SD)	48 ± 23.106	37 ± 21.508	.007

aOR: adjusted odds ratio; 95% CI: confidence interval 5–95%; IQR: interquartile range; NIHSS: National Institute of Health Stroke Scale; NC: not confirmed on multivariable analysis; IND: alterations on the neurologic examination during carotid clamping; SD: standard deviation; TIA: transient ischemic attack; time to revascularization: time to revascularization from index event.

Figure 1. 30 day postoperative adverse events. ND: alterations on the neurologic examination during carotid clamping. *Confirmed by multivariable analysis.

Table 3. 30-Day postoperative adverse events following carotid intervention.

Variables 30 days	Control N = 85 (%)	IND n = 79 (%)	p Value	Multivariable
Stroke	3 (3)	11 (14)	.017	aOR: 4.30; 95% CI: 1.10–16.71; p=.035
Clavien–Dindo ≥ 2	9 (11)	20 (25)	.014	aOR: 2.86; 95% CI: 1.21–6.75; p=.016
CNI	10 (12)	7 (9)	.542

aOR: adjusted odds ratio; 95% CI: confidence interval 5–95%; CNI: cranial nerve injury; IND: alterations on the neurologic examination during carotid clamping; Clavien–Dindo ≥ 2: stroke, surgical hematoma, hyperperfusion syndrome, postoperative hypotension demanding adrenergic support.

Data availability statement

This study database is available in Clinical registry: https://www.researchregistry.com. Identifying number: researchregistry4929. Hyperlink to the registration: https://www.researchregistry.com/register-now#home/registrationdetails/5cf4721053761c000cc1c25a/