Related Experiment Videos
Emergency carotid endarterectomy
H H Eckstein1, H Schumacher, K Klemm
1Department of Surgery, Division of Vascular Surgery, University of Heidelberg Medical School, Heidelberg, Germany.
Insights
Emergency carotid endarterectomy (CEA) offers therapeutic benefits for select neurologically unstable patients with ischemic stroke. Completion angiography is essential for successful outcomes in this critical intervention.
Area of Science:
- Vascular Surgery
- Neurology
- Interventional Cardiology
Background:
- Neurologically unstable patients experiencing ischemic stroke often require urgent intervention.
- Carotid endarterectomy (CEA) is a primary treatment for carotid artery stenosis.
- The efficacy of emergency CEA in critically ill patients remains a subject of investigation.
Purpose of the Study:
- To evaluate the therapeutic efficacy of emergency carotid endarterectomy (CEA) in neurologically unstable patients.
- To analyze neurological outcomes, long-term survival, and stroke recurrence rates following emergency CEA.
- To determine the role of completion angiography and thrombolytic agents in emergency CEA procedures.
Main Methods:
- A consecutive series of 71 emergency CEAs were performed between 1980 and 1998.
- Patients were classified into three groups: acute stroke, progressive stroke, and crescendo transient ischemic attacks.
- Neurological outcomes were assessed using the modified Rankin scale; long-term survival and stroke recurrence were analyzed.
Main Results:
- Recovery rates (modified Rankin 0-3) were 56.3% for acute stroke, 76.4% for progressive stroke, and 80.9% for crescendo TIAs.
- Major stroke/mortality rates (modified Rankin 4-6) were 43.7%, 23.6%, and 19.1% respectively.
- Five-year stroke-free survival was 53.7%, with 85.3% remaining stroke-free during follow-up (excluding perioperative strokes).
Conclusions:
- Emergency CEA can be a valuable therapeutic option for carefully selected neurologically unstable patients.
- Completion angiography is a mandatory component of emergency CEA to ensure technical success.
- Emergency CEA should be considered as part of the therapeutic strategy for acute ischemic stroke management.
Objective:
Evaluation of the therapeutical efficacy of emergency carotid endarterectomy (CEA) in neurologically unstable patients.
Patients And Methods:
Three groups of a consecutive series of 71 emergency CEAs performed from 1980 to July 1998 were classified: (1) acute onset of severe stroke (n = 16), (2) progressive stroke/stroke in evolution (n = 34), and (3) crescendo transient ischemic attacks (n = 21). Cerebral coma, cerebral haemorrhage, and major ischemic stroke established in cranial computed tomography scans were contraindications for surgery. The neurological outcome was assessed by the modified Rankin scale. Long-term survival and long-term stroke recurrences were analyzed.
Results:
The recovery/minor stroke rates (Rankin 0-3) in acute stroke, progressive stroke, and crescendo transient ischemic attacks were 56.3, 76.4 and 80.9%, respectively; the combined major stroke/mortality rates (Rankin 4-6) were 43.7, 23.6 and 19.1%, respectively. Intraoperative angiography in 39 patients detected early carotid reocclusions in 2 and intracranial embolism in 7 patients. Local application of thrombolytic agents (n = 5) may contribute to a better neurological outcome in emergency CEA. Life table probabilities of major strokefree survival were 74.5, 71.6, and 53.7% after 1, 2, and 5 years, respectively (including perioperative strokes). Life table probabilities to suffer no stroke recurrence during follow-up were 96.7, 96.7 and 85.3%, respectively (perioperative strokes excluded).
Conclusions:
Emergency CEA may be worthwhile in selected patients. Completion angiography is mandatory. Emergency CEA should be included in therapeutic strategies for ischemic stroke.