Carotid Endarterectomy With Concomitant Distal Endovascular Intervention Is Associated With Increased Rates of Stroke and Death

ABSTRACT Objective Carotid endarterectomy (CEA) with concomitant distal endovascular intervention (CEA+D) is infrequently necessary, and often a salvage maneuver when complications occur during CEA. This study aims to determine if there are preoperative risk factors associated with CEA requiring CEA+D and evaluate outcomes compared to isolated CEA. Methods The Vascular Quality Initiative (VQI) CEA registry was utilized to identify patients undergoing CEA and CEA+D for asymptomatic or symptomatic carotid stenosis from 2013-2019. Data regarding distal intervention includes whether angioplasty or stent of the distal ICA and/or bifurcation was required, but information regarding indication or if intervention was planned is not included. X 2 and ANOVA were used, to evaluate categorical and continuous perioperative variables. Variables with p Results From 2013-19, 327 CEA+D were identified and compared to 105,192 isolated CEA. CEA+D patients were more likely to have prior ipsilateral CEA (CEA: 1.8%, CEA+D: 4.9%; p CEA+D was associated with significantly increased rates of stroke in both asymptomatic (CEA+D: 3.9%, CEA: 0.9%; p 135 minutes, diabetes, hypertension, shunt for indication, symptomatic status, prior ipsilateral CEA, contralateral ICA occlusion, urgent/emergent procedure, IV medications for hemodynamic instability, and re-exploration at initial operation. Conclusion While markers of more significant cardiovascular disease burden were associated with use of CEA+D, their power to predict CEA+D use is limited. In cases where CEA+D is employed, CEA+D is associated with significantly higher rates of perioperative stroke and mortality in comparison to isolated CEA in both asymptomatic and symptomatic patients, which can be useful framing expected outcomes after these procedures.