Abstract
Introduction: Carotid endarterectomy is used for treating patients with severe stenosis (>70%) or cerebrovascular symptoms secondary to internal carotid disease. Eagle score has been used as a predictor of cardiovascular events after major surgery. This study aims to assess the use of Eagle Score as a predictor of major cardiovascular events after carotid endarterectomy.
Materials and methods: A retrospective observational cross-sectional study was conducted. Medical records of patients who underwent carotid endarterectomy between 2017 and 2021 were reviewed. The EAGLE scale was performed pre-surgically to assess the risk of the risk of major complications after carotid endarterectomy from surgery to the last day of hospitalization.
Discussion: A total of 19 patients were assessed pre-surgically using the Eagle scale score and subsequently underwent carotid endarterectomy (Mean age of 77 years-old). The surgical procedure was predominantly performed on symptomatic patients (89.4%), including 10 patients (59%) with a history of transient ischemic attack (TIA) and 7 patients (41%) with a cerebrovascular attack. Previous diagnostic imaging indicated severe carotid artery stenosis in 18 patients (94.7%). According to the EAGLE Scale, the majority presented a moderate risk (68.4%), among whom 5 patients experienced minor complications, and none experienced major complications.
Conclusions: Patients with minor cardiovascular complications after carotid endarterectomy were most commonly adjudicated as moderate risk according to the Eagle score. Further studies with large sample sizes are required to elucidate the role of Eagle Score as predictor of major cardiovascular events after carotid endarterectomy.
References
The Texas Heart Institute. Endarterectomía carotídea. The Texas Heart Institute. https://www.texasheart.org/heart-health/heart-information-center/topics/endarterectomia-carotidea/
Saba L, Mallarini G. A comparison between NASCET and ECST methods in the study of carotids: evaluation using multi-detector-row CT angiography. Eur J Radiol. 2010;76(1):42-7. https://doi.org/10.1016/j.ejrad.2009.04.064
Cohen JE, Frucella G. Indicaciones de endarterectomía en pacientes con esternosis carotídea sintomática y asintomática. Rev Argent Neurocirugía. 1997;11(1):11-37. https://aanc.org.ar/ranc/items/show/899
Fleck J, Biller J. Indicators of carotid endarterectomy: AHA guidelines. Semin Cerebrovasc Dis Stroke. 2002;2(4):287-91. https://doi.org/10.1053/scds.2002.130315
Eagle KA, Singer DE, Brewster DC, Darling RC, Mulley AG, Boucher CA. Dipyridamole-thallium scanning in patients undergoing vascular surgery: optimizing preoperative evaluation of cardiac risk. JAMA. 1987;257(16):2185-9. https://jamanetwork.com/journals/jama/fullarticle/365744
Aziz I, Lewis RJ, Baker JD, Virgilio C. Cardiac morbidity and mortality following carotid endarterectomy: the importance of diabetes and multiple eagle risk factors. Ann Vasc Surg. 2001;15(2):P243-6. https://doi.org/10.1007/s100160010056
Benítez-Rodríguez C, Calderón-Llamas M, Nuño-Escobar C, Gavilánez-Chávez G, Llamas-Macías FJ, González-Bojórquez JL, et al. Post-surgical complications in patients undergoing carotid endarterectomy. Cross-sectional study. Rev Mex Angiología. 2021;49(4):117-22. https://doi.org/10.24875/RMA.21000034
de Virgilio C, Toosie K, Lewis RJ, Stabile BE, Baker JD, White R, et al. Cardiac morbidity and operative mortality following lower-extremity amputation: the significance of multiple eagle criteria. Ann Vasc Surg. 1999;13(2):204-8. https://doi.org/10.1007/s100169900243
Wong T, Detsky AS. Preoperative cardiac risk assessment for patients having peripheral vascular surgery. Ann Intern Med. 1992;116(9):743-53. https://doi.org/10.7326/0003-4819-116-9-743
Orrapin S, Rerkasem K. Carotid endarterectomy for symptomatic carotid stenosis. Cochrane Database Syst Rev. 2017;6. https://doi.org/10.1002/14651858.CD001081.pub3
AbuRahma AF, Avgerinos ED, Chang RW, Darling RC, Duncan AA, Forbes TL, et al. Society for vascular surgery clinical practice guidelines for management of extracranial cerebrovascular disease. J Vasc Surg. 2022;75(1):4S-22S. https://doi.org/10.1016/j.jvs.2021.04.073
Blay E, Balogun Y, Nooromid MJ, Eskandari MK. Early carotid endarterectomy after acute stroke yields excellent outcomes: an analysis of the procedure-targeted ACS-NSQIP. Ann Vasc Surg. 2019;57:194. https://doi.org/10.1016/j.avsg.2018.10.023
Ferguson GG, Eliasziw M, Barr HWK, Clagett GP, Barnes RW, Wallace MC, et al. The North American Symptomatic Carotid Endarterectomy Trial. Stroke. 1999;30(9):1751-8. https://doi.org/10.1161/01.STR.30.9.1751
Warlow C. MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. Lancet. 1991;337(8752):1235-43. https://doi.org/10.1016/0140-6736(91)92916-P
Parmar CD, Torella F. Prediction of major adverse cardiac events in vascular surgery: are cardiac risk scores of any practical value? Vasc Endovasc Surg. 2009;44(1):14-9. https://doi.org/10.1177/1538574409349320
Ceballos Burbano O, Márquez Rodríguez JA, Messier Rodríguez J, Azuero Escallón JA, Olaya Rodríguez AF, León Guzmán E. Disminución de complicaciones neurológicas perioperatorias en pacientes con endarterectomía carotídea bajo anestesia regional. Acta Neurol Colomb. 2019;35(3):130-9. https://doi.org/10.22379/24224022260
Knappich C, Kuehnl A, Haller B, Salvermoser M, Algra A, Becquemin JP, et al. Associations of perioperative variables with the 30-day risk of stroke or death in carotid endarterectomy for symptomatic carotid stenosis. Stroke. 2019;50(12):3439-48. https://doi.org/10.1161/STROKEAHA.119.026320
Kakisis JD, Antonopoulos CN, Mantas G, Moulakakis KG, Sfyroeras G, Geroulakos G. Cranial nerve injury after carotid endarterectomy: Incidence, risk factors, and time trends. Eur J Vasc Endovasc Surg. 2017;53(3):320-35. https://doi.org/10.1016/j.ejvs.2016.12.026
Beasley WD, Gibbons CP. Cranial nerve injuries and the retrojugular approach in carotid endarterectomy. Ann Royal Coll Surg Engl. 2008;90(8):685-8. https://doi.org/10.1308/003588408X318138
Florez Amaya PC. Desenlaces de endarterectomía carotidea temprana en la Fundación CardioInfantil - La Cardio en el periodo comprendido desde el 2018 al 2021 [Trabajo de grado, Universidad del Rosario, Colombia]. 2022. https://repository.urosario.edu.co/server/api/core/bitstreams/424ef22e-eda9-44f7-a8c0-0b43833b6659/content

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