[Angiomorphologic indications for emergency carotid reconstruction]

Area of Science:

• Vascular Surgery
• Neurology
• Cardiovascular Medicine

Background:

• Carotid artery reconstruction is a standard procedure for significant internal carotid artery stenosis.
• The necessity of emergency surgery based solely on angiomorphological instability in neurologically stable patients remains a subject of debate.

Purpose of the Study:

• To evaluate the indication for urgent carotid reconstruction in neurologically stable patients with severe internal carotid artery stenosis based on angiomorphological criteria.
• To compare the outcomes of emergency versus elective carotid endarterectomy.

Main Methods:

• Retrospective analysis of 101 patients (out of 720) who underwent carotid reconstruction for >90% internal carotid artery stenosis.
• Patients were categorized into elective (n=74, surgery delayed 1-5 days with medical treatment) and urgent (n=27) groups.
• Comparison of preoperative transient ischemic attacks (TIAs) and perioperative TIAs between the two groups.

Main Results:

• No preoperative TIAs occurred in the elective group.
• One perioperative TIA occurred in each group (elective and urgent).
• The preoperative stroke incidence was higher in the urgent carotid reconstruction group compared to the elective group.

Conclusions:

• Emergency carotid endarterectomy is not indicated based solely on angiomorphological findings in neurologically stable patients.
• Careful preoperative preparation, including anticoagulation or antiaggregation therapy, is crucial for patients awaiting carotid reconstruction.
• Elective surgery with appropriate medical management appears to yield better outcomes than emergency intervention in this patient cohort.