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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Emergency carotid thromboendarterectomy: safe and effective
C Schneider1, K Johansen, R Königstein
1Department of Visceral, Trauma, and Vascular Surgery, Krankenhaus der Barmherzigen Brüduder, Teaching Hospital of the University of Mainz, Nordallee 1, 54292 Trier, Germany.
World Journal of Surgery
|September 29, 1999
Summary
Emergency carotid thromboendarterectomy (CTEA) is safe for acute neurologic deficits without severe brain injury. This study found no mortality or complications in emergency CTEA patients, suggesting improved outcomes.
Area of Science:
- Vascular Surgery
- Neurology
- Interventional Cardiology
Background:
- Emergency carotid thromboendarterectomy (CTEA) for crescendo transient ischemic attacks or stroke-in-evolution remains controversial.
- Published reports indicate high operative mortality and limited neurologic improvement for emergency CTEA.
Purpose of the Study:
- To compare the safety and outcomes of emergency CTEA with elective CTEA.
- To evaluate the efficacy of emergency CTEA in patients with acute, persistent, or crescendo neurologic deficits.
Main Methods:
- A retrospective comparison of 43 patients undergoing emergency CTEA versus 237 patients undergoing elective CTEA.
- Emergency CTEA protocol included Doppler ultrasonography, CT scans, arteriography, and heparin; exclusions were coma or CT evidence of infarction with edema.
Main Results:
- No mortality or central neurologic complications occurred in the 43 emergency CTEA patients.
- Elective CTEA patients had no deaths and one temporary hemiparesis (0.4% morbidity).
- Emergency CTEA demonstrated excellent outcomes regardless of deficit severity when contraindications were absent.
Conclusions:
- Emergency carotid reconstruction can be performed safely with excellent outcomes.
- Absence of coma or unstable blood-brain barrier on CT scan are key factors for successful emergency CTEA.
- This approach offers a viable option for managing acute neurologic deficits caused by carotid artery disease.
