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Carotid Endarterectomy Benefits Patients with CKD and Symptomatic High-Grade Stenosis

Anna Mathew^*, Michael Eliasziw, P.J. Devereaux^,, Jose G. Merino^||, Henry J.M. Barnett^¶,**, Amit X. Garg^*,, and for the North American Symptomatic Carotid Endarterectomy Trial (NASCET) Collaborators

*Division of Nephrology,
^¶Department of Clinical Neurological Sciences,
**John P. Robarts Research Institute,
Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada;
Department of Medicine, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada;
Departments of Clinical Epidemiology and Biostatistics and
Medicine, McMaster University, Hamilton, Ontario, Canada; and
^||Section on Stroke Diagnostics and Therapeutics, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland

Correspondence: Dr. Amit Garg, London Kidney Clinical Research Unit, Room ELL-101, Westminster, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario N6A 4G5. Phone: 519-685-8502; Fax: 519-685-8072; E-mail: amit.garg{at}lhsc.on.ca

Received for publication March 15, 2009. Accepted for publication August 28, 2009.

Endarterectomy is generally recommended for symptomatic high-grade (70 to 99%) stenosis of the internal carotid artery, but whether this procedure is beneficial among patients with chronic kidney disease (CKD) is unknown. In this re-analysis of data from the North American Symptomatic Carotid Endarterectomy Trial, we included patients with symptomatic stenosis and either stage 3 CKD (n = 524) or preserved kidney function (n = 966; estimated GFR 60). For medically treated patients with high-grade stenosis, risk for ipsilateral stroke at 2 yr was significantly higher in patients with CKD than in those with preserved renal function (31.6 versus 19.3%; P = 0.042); carotid endarterectomy significantly reduced this risk by 82 and 51%, respectively. To prevent one ipsilateral stroke, the number needed to treat by endarterectomy was four for patients with CKD and 10 for patients with preserved renal function. Compared with patients with preserved renal function, those with CKD had similar rates of perioperative stroke and death but higher rates of cardiac events. In conclusion, patients with stage 3 CKD and symptomatic high-grade carotid stenosis gain a large benefit in stroke risk reduction after endarterectomy.

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				R. F. Gottesman and S. M. Sozio Management of Symptomatic Carotid Stenosis in Individuals with CKD J. Am. Soc. Nephrol., January 1, 2010; 21(1): 9 - 11. [Full Text] [PDF]

Copyright © 2009 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673