Diabetes and asymptomatic carotid stenosis: Does diabetic disease influence the outcome of carotid endarterectomy? A 10-year single center experience

Abstract Background Few studies have focused directly on carotid endarterectomy (CEA) in symptomatic and asymptomatic diabetic patients (DPs), reporting controversial outcome. We compared perioperative (30-day) and late outcome in DPs versus non-DPs undergoing CEA for severe asymptomatic carotid disease. Methods Over 10 years, data were prospectively collected for DPs and non-DPs undergoing CEAs for asymptomatic severe carotid disease. All procedures were eversion CEAs. All patients had neurological follow-up and duplex ultrasound scan at 1, 6 and 12 months, then yearly, after surgery. Results Of 391 CEAs performed in 374 patients, 112 (28.7%) were in DPs. There were no perioperative deaths or strokes either in DPs or non-DPs. A significantly higher incidence of cardiac complications occurred in DPs (p < .01). A complete follow-up (mean, 6.1 years) was obtained for 348 patients. No recurrent stenoses or late occlusions were diagnosed in DPs or non-DPs. At 10 years, the risk of death was up to 4.6 times higher in DPs, with a significant prevalence of cardiac-related deaths (p < .01). Conclusions CEA can be performed with no perioperative stroke risk or mortality, for asymptomatic disease in both DPs and non-DPs. The absence of fatal strokes associated with a significantly higher risk of cardiac-related death in the long-term would point to the need to improve prevention strategies for postoperative cardiac risk in DPs.