Influence of chronic renal insufficiency on outcomes following carotid revascularization

Objectives: To examine the perioperative and longterm outcomes of patients undergoing carotid revascularization and to determine the influence moderate or severe renal insufficiency may have on these outcomes. Design: Retrospective database review. Setting: Academic tertiary hospital. Patients: Patients undergoing carotid endarterectomy and carotid angioplasty and stenting from 1996 to 2006. Intervention: Carotid revascularization. Main Outcome Measure: Glomerular filtration rate (GFR) was calculated based on the Modification of Diet in Renal Disease equation. Groups were analyzed by stages 0 to 2 (GFR ≥60 mL/min/1.73m ²) vs stage 3 (GFR <60 and ≥30 mL/min/1.73m ²) vs stages 4 and 5 (GFR <30 mL/min/1.73m ²). Results: Nine hundred twenty-one carotid interventions were performed (750 carotid endarterectomy, 171 carotid angioplasty and stenting). The overall 30-day mortality and morbidity rates were 1.1% and 16.9%, respectively.Sixty-six percent of patients had normal renal function (stages 0-2). Twenty-eight percent of patients had moderate renal insufficiency (stage 3) and 6% of patients had severe renal insufficiency (stages 4-5). The 30- day stroke rates for groups were 2.98% (normal renal function), 2.67% (moderate renal insufficiency), and 5.45% (severe renal insufficiency) (P=.54). Thirty-day mortality rates between groups were 0.66% (normal renal function), 1.15% (moderate renal insufficiency), and 5.45% (severe renal insufficiency) (P=.005). For carotid endarterectomy, no difference in freedom from stroke existed based on level of renal function. For carotid angioplasty and stenting, patients with severe renal insufficiency exhibited significantly lower rates of freedom from stroke. Conclusions: Chronic kidney disease is prevalent among patients undergoing carotid revascularization. Overall, patients with moderate renal function have similar outcomes. However, those with severe renal insufficiency have significantly higher 30-day mortality when undergoing carotid revascularization.