Objectives Diabetes is prevalent in most patients undergoing carotid revascularization and is suggested as a marker of poor outcome after carotid endarterectomy (CEA). Data on outcome of diabetic patients undergoing carotid angioplasty and stenting (CAS) are limited. The aim of this study was to investigate early and 6-year outcome of diabetic patients undergoing CAS compared with those of a concurrent CEA series. Methods The database of patients undergoing carotid revascularization for primary carotid revascularization was queried from 2001 to 2009. Diabetic patients were defined as those with established diagnosis and/or receiving oral hypoglycemic or insulin therapy. Multivariate and Kaplan Meier analyses were performed on perioperative (30 days) and late outcomes. Results A total of 2,197 procedures, 1,117 by CEA and 1,080 by CAS (29% female, mean age71.3 years) were reviewed. Diabetes was prevalent in 629(28.6%) and was most common in CAS than in CEA patients (30.7% vs 26.6%, p=0.042). Diabetic patients were younger (p=0.005) and more frequently had hypertension (p=0.015) or coronary disease (p=0.019). Perioperative stroke/death rate was 2.3% (36/1568) in non-diabetic vs 2.7% (17/629) in diabetic patients (p=0.54); 3.4% in diabetic CEA group and 2.1% in diabetic CAS group. At multivariate analyses diabetes was found predictor of perioperative stroke/death only in CEA group (OR 3.04; 95%CI 1.107-8.362; p=0.031) but not in CAS group (p=0.45) or in overall patients (p=0.38). Six-year survival was 78.4% in diabetic and 82.5% in non-diabetic (p=0.15). The 6-year risk of late stroke was similar (5.0%) in diabetic and non diabetic patients. Six-year restenosis estimates were 5% in diabetic and 8% in non-diabetic patients (p=0.1). Survival, late stroke and restenosis rates between diabetic and non-diabetic were similar in CAS and CEA groups. Conclusions Diabetic patients are not at greater risk of perioperative morbidity, mortality and late stroke after CAS.
Diabetes is Not a Predictor of Adverse Outcome after Carotid Revascularization with Carotid Angioplasty and Stenting (CAS)
CIERI, ENRICO;VERZINI, Fabio;SIMONTE, GIOELE;CAO, Piergiorgio
2011
Abstract
Objectives Diabetes is prevalent in most patients undergoing carotid revascularization and is suggested as a marker of poor outcome after carotid endarterectomy (CEA). Data on outcome of diabetic patients undergoing carotid angioplasty and stenting (CAS) are limited. The aim of this study was to investigate early and 6-year outcome of diabetic patients undergoing CAS compared with those of a concurrent CEA series. Methods The database of patients undergoing carotid revascularization for primary carotid revascularization was queried from 2001 to 2009. Diabetic patients were defined as those with established diagnosis and/or receiving oral hypoglycemic or insulin therapy. Multivariate and Kaplan Meier analyses were performed on perioperative (30 days) and late outcomes. Results A total of 2,197 procedures, 1,117 by CEA and 1,080 by CAS (29% female, mean age71.3 years) were reviewed. Diabetes was prevalent in 629(28.6%) and was most common in CAS than in CEA patients (30.7% vs 26.6%, p=0.042). Diabetic patients were younger (p=0.005) and more frequently had hypertension (p=0.015) or coronary disease (p=0.019). Perioperative stroke/death rate was 2.3% (36/1568) in non-diabetic vs 2.7% (17/629) in diabetic patients (p=0.54); 3.4% in diabetic CEA group and 2.1% in diabetic CAS group. At multivariate analyses diabetes was found predictor of perioperative stroke/death only in CEA group (OR 3.04; 95%CI 1.107-8.362; p=0.031) but not in CAS group (p=0.45) or in overall patients (p=0.38). Six-year survival was 78.4% in diabetic and 82.5% in non-diabetic (p=0.15). The 6-year risk of late stroke was similar (5.0%) in diabetic and non diabetic patients. Six-year restenosis estimates were 5% in diabetic and 8% in non-diabetic patients (p=0.1). Survival, late stroke and restenosis rates between diabetic and non-diabetic were similar in CAS and CEA groups. Conclusions Diabetic patients are not at greater risk of perioperative morbidity, mortality and late stroke after CAS.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
