37 Does modified Rankin Score Matter? A five-year retrospective analysis of the National Vascular Registry to assess the impact of stroke severity on carotid artery endarterectomy outcomes

Abstract Introduction Carotid endarterectomy (CEA) is performed to reduce stroke risk in patients with carotid artery stenosis following a non-disabling ischaemic stroke (mRS<3). There is some evidence that individuals with a disabling stroke may also benefit from surgery. Analysis of the National Vascular Registry (NVR) data was performed to assess outcomes in patients who underwent CEA following a disabling ischaemic stroke. Methods A five-year retrospective analysis of the NVR was performed. Pre-operative, peri-operative and post-operative variables were compared between group 1 (mRS<3) and group 2 (mRS≥3). P<0.05 was deemed significant. Results There were 17382 individuals in group 1 and 1753 in group 2. Group 2 was more frail, had a higher ASA score and more pre-operative co-morbidities. Days from symptoms to surgery were similar but group 2 were more likely to receive pre-operative thrombolysis (p=3.52E-37). Group 2 had longer hospital admissions (p=1.05E-107) and higher rates of admission (p=0.011) and re-admission (p=0.001) to critical care. Group 2 was more likely to suffer a number of post-operative complications within the index admission. Group 1 was more likely to be alive on discharge (p=5.04E-05), whilst Group 2 was more likely to be readmitted to hospital (p=0.031) and suffer a stroke (0.0001) at 30-days. Conclusion CEA in patients following a disabling stroke is associated with longer inpatient stays, requiring greater critical care input. Patients are more likely to suffer short and long term post-operative complications, including a stroke within 30-day post discharge. Current guidance should be adhered.