IS THE 3% (6%) QUALITY THRESHOLDS FOR PERIOPERATIVE DEATH AND/OR STROKE RATE IN INTERNAL CAROTID ENDARTERECTOMY REALISTIC AND ATTAINABLE IN REAL WORLD DATA? gregor.siegl@medunigraz.at

353-07

IS THE 3% (6%) QUALITY THRESHOLDS FOR PERIOPERATIVE DEATH AND/OR STROKE RATE IN INTERNAL CAROTID ENDARTERECTOMY REALISTIC AND ATTAINABLE IN REAL WORLD DATA?

4

Austria

Oral or Poster

ESVS guidlines claim a quality threshold for perioperative death and stroke of <3% in asymptomatic and <6% for symptomatic patients undergoing internal carotid endarterectomy. In recent years these thresholds were questioned and lowering was proposed. The goal of this investigation was to determine our 10-years perioperative death- and strokerate of patients undergoing carotid endarterectomy including data after discharge.

All patients undergoing internal carotid endarterectomy from 1/1 2014 to 12/31 2023 were included. All cases with one or more of the following perioperative (30-days) events in all regional public hospital were detected: death, reoperation, stroke, imaging like computed tomography or magnetic resonance imaging. Perioperative death- and strokerates were calculated, with subgroup analysis for asymptomatic and symptomatic patients.

Exactly 2500 patients underwent internal carotid endarterectomy. Mean age was 71.3 years, 67.6% were male, 32.4% female, 76.6% asymptomatic, 23.4% symptomatic. Postoperatively 2.3% (45/1871) of the asymptomatic and 2.6% (15/569) of the symptomatic patients had to undergo reoperation for bleeding (79.3%) or technical complications (20.7%). There were 14 perioperative deaths, 0.5% (asymptomatic) and 0.7% (symptomatic) while strokerate was 1.7% (asysmptomatic) and 4.8% (symptomatic). Concluding as combined endpoint of 2.1% (asymptomatic) and 5.5% (symptomatic) perioperative stroke and death.

Data from registries often lack information after discharge. A significant portion of events in our cohort occurred after discharge. Results with thorough follow-up of our high volume center showed results within the frame of ESVS recommendations. Therefore we believe the current quality thresholds to be very realistic, reflective of real world practice and should not be changed.