Emma Rooney Wins Robert Smith Resident Award

September 2019

General surgery resident Emma Rooney, MD, received the Robert B. Smith, III, MD, Resident Award for her presentation, "Carotid Endarterectomy in Young Patients: A Population Based Study," at the 7th Annual Scientific Sessions of the Georgia Vascular Society. Her faculty mentor for the study was Guillermo Escobar, MD, program director of the Emory Vascular Surgery Fellowship and Residency.

Named in honor of retired Emory vascular surgeon Dr. Robert B. Smith, III, the award is made possible through a generous contribution from the Georgia Vascular Foundation (GVF), and recognizes the significant contribution of residents and fellows to their chosen areas of research. Dr. Smith was the first recipient of the GVF's Lifetime Achievement Award for his dedication to teaching and training residents and fellows in the field of vascular surgery.

Dr. Rooney's study set out to evaluate the cohort characteristics and procedural outcomes after carotid endarterectomy (CEA) in patients 50 years of age or younger on a wider basis than existing single-institution studies, particularly since younger patients face earlier mortality after stroke than older patients. CEA is the surgical removal of plaque buildup inside the carotid artery to reduce the danger of stroke.

Using the 2011-2016 carotid endarterectomy-targeted American College of Surgeons National Surgical Quality Improvement Program database, the investigation identified 21,204 patients who underwent CEA. Patients with diagnosis codes for dissections, aneurysms, vasculitis, or thromboembolic events were excluded. The remainder were divided into cohorts of younger or older than 50 years of age, and characteristics, comorbidities, symptoms, and post-procedural outcomes evaluated between them. Multivariate logistic regression models were created to adjust for group differences.

The results showed that 1.7 percent of all patients who underwent CEA were aged 50 years or younger, and that these patients presented with stroke more often than older patients (60.7 percent vs. 45 percent). The younger cohort had more females than the older (48 percent vs. 38.4 percent), more smokers (62.7 percent vs. 26.1 percent), and more preoperatively symptomatic patients (59.5 percent vs. 42.7 percent).

There were no differences in the severity of stenosis, presence of contralateral occlusion, surgical technique, or use of shunt between the two groups. In the combined cohort, 2.1 percent of patients had a stroke, 1.7 percent had a myocardial infarction, and 0.67 percent died within 30 days of surgery. In multivariate models adjusted for patient demographic and clinical characteristics, there were no differences in the incidence of perioperative stroke, myocardial infarction, or death between the two groups.

Dr. Rooney and her team concluded that carotid endarterectomy in younger patients was strongly associated with symptomatic stenosis, stroke, and smoking. No differences were found in perioperative outcomes between younger and older patients, suggesting that CEA was safe for younger patients. The team advised that additional studies were needed to determine carotid stenosis screening in these patients to allow for early CEA and subsequent prevention of stroke.