To investigate the effect of diabetes on the occurrence of stroke and death after carotid endarterectomy.

According to the inclusion and exclusion criteria, 795 patients who were diagnosed with carotid stenosis and underwent carotid endarterectomy from January 2017 to January 2019 were included in 3 centers, Zhongshan Hospital affiliated to Fudan University, Changhai Hospital affiliated to Naval Medical University, and the Shanghai Seventh People's Hospital affiliated to Shanghai University of Traditional Chinese Medicine. The patients were divided into diabetes mellitus (DM) group (n=215) and non-diabetes mellitus (NDM) group (n=580) according to whether they had diabetes. The clinical data of patients were collected and analyzed with univariate, multivariate, and survival analysis of stroke and death events 30 days after operation and within 3 years of follow-up. Logistic regression analysis was used for univariate analysis of categorical outcome variables. Cox regression equation was used for multivariate analysis, and survival curves were plotted by using the Kaplan-Meier method.

The success rate of CEA surgery is 100%. The incidence of adverse events at 30 days after surgery showed: stroke and death in 4 cases (0.5%), serious stroke and death in 3 cases (0.4%), stroke and TIA in 7 cases (0.9%), and no patient died. Adverse events at 3-year follow-up showed: 13 (1.6%) stroke and death, 6 (0.8%) serious stroke and death, 15 (1.9%) stroke or TIA, and 1 patient died (0.1%). The univariate and multivariate results of stroke and death 30 days after surgery did not significantly associated risk factors. The results of univariate analysis of adverse events during the 3-year postoperative follow-up showed that chronic obstructive pulmonary disease was a high risk factor for stroke or death after CEA (HR=13.8, 95%CI: 1.8-106.0, P=0.011). Multivariate analysis after adjusting for variables showed that age (HR: 1.0; 95%CI: 0.9-1.0; P=0.034), previous alcohol consumption (HR: 13.1; 95%CI: 1.7-100.3; P=0.013), and chronic Obstructive pulmonary disease (HR: 13.1; 95%CI: 1.7-100.3; P=0.013) were independent risk factor for stroke or death after CEA. The results of 3-year follow-up survival analysis showed that the 1-year, 2-year and 3-year survival rates of DM group were 99.5%, 99.0% and 98.3%; And that in the NDM group were 99.5%, 99.5% and 97.7%, respectively.

The risk of stroke and death after CEA in patients with carotid artery stenosis in the diabetic group was higher than that in the non-diabetic group, but there was no significant correlation between diabetes and the occurrence of stroke and death within 3 years after CEA.