Stratification of anesthesiological and surgical risk in patients undergoing carotid endarterectomy: prelimininary dataof an observational study

Background and Goal of Study: The study was aimed to define clinical and humoral factors affecting short-medium-and long-term outcomes of carotid thrombo-endarterectomy, in addition to usual anesthesiological scores: ASA, Revised Cardiac Risk Index (RCRI) and Vascular Study Group of New England Cardiac Risk Index (VSG-CRI) materials and methods: This observational study enrolled all consecutive patients candidates to TEAC under general (GA) or regional (RA) anaesthesia. Anaesthesiological risk was stratified according to ASA(1-5), RCRI (1-5) and VSG-CRI (0-14) criteria. Markers of organ damage (Natriuretic Brain Peptide (NBP), Troponin I, were assessed at 24 and 48 hours after the procedure. All patients were reached by phone call after one, three, six and twelve months from the procedure in order to assess neurological and cardiac complica- tions. Statistical analysis was descriptive. Independent samples were compared by Mann-Whitney U test and Wilcoxon signed rank test for paired data. Logisticregression was used to analyze predictors of 30-days major adverse cardio- vascular events (MACE). Results and Discussion: A total of 201 patients undergone elective TEAC were studied. The anesthetic procedure was RA in 179 patients (89%) and GA in 22 (11%). Common anaesthesiological scales (ASA, RCRI) as well as more recent ones (VSG-CRI) apparently failed to correctly stratify the risk of major adverse events The most unfavourable outcomes were observed in patients affected by ischemic cardiac disease not previously treated either with coronary angioplasty or coronary by-pass surgery (p< 0.02) in patients with chronic obstructive pulmonary disease (COPD) (p< 0.04), and impaired renal function (p=0.008) Similarly, complications were more unfavourable in patients unable to compensate with at least 20 mmHg the blood pressure change after clamping during surgical procedure. (p=0.008) Humoral markers tended to increase after surgical procedure; troponin cor- relates with MACE (p=0.04) and NBP correlates with MACE incidences too. (p=0.04). Conclusion(s): The study indicates that some clinical factors usually neglect- ed in clinical practice, when adequately evaluated in the