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Updated: Jul 28, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Prophylactic urgent revascularization of the internal carotid artery in the symptomatic patient
C Peiper1, J Nowack, K Ktenidis
1Surgical University Clinic, RWTH Aachen, Germany. ch.peiper@chir.rwth-aachen.de
Insights
Urgent carotid artery surgery for symptomatic stenosis significantly reduces stroke risk and complications. This approach prevents new neurological defects and mortality compared to elective procedures.
Area of Science:
- Vascular Surgery
- Cerebrovascular Disease
- Neurosurgery
Background:
- Symptomatic patients with internal carotid artery (ICA) stenosis face high risks of thrombosis and embolization before surgery.
- String sign or ulcerative stenosis of the ICA indicates significant cerebrovascular insufficiency.
Purpose of the Study:
- To evaluate the safety and efficacy of urgent carotid endarterectomy for symptomatic ICA stenosis.
- To compare outcomes of urgent versus elective revascularization procedures.
Main Methods:
- 186 ICA revascularization procedures were performed over one year.
- 26 procedures met urgent criteria (symptoms + severe stenosis/ulceration).
- Urgent group outcomes compared to 157 elective procedures.
Main Results:
- Urgent surgery showed no postoperative neurological defects, versus 3.8% in the elective group.
- Mortality was 0% in the urgent group, compared to 2.7% in the elective group.
- Fewer local complications were observed in the urgent surgery cohort.
Conclusions:
- Urgent desobliteration of symptomatic ICA stenosis is recommended.
- This strategy effectively prevents early thrombosis and neurological deficits.
- Urgent revascularization can be performed without increased complication rates.
Background:
The symptomatic patient showing a string sign or ulcerative stenosis of the internal carotid artery (ICA) is subject to a high risk of arterial thrombosis or persisting intracranial embolization during the waiting period before operative revascularization.
Patients And Methods:
During one year 186 operative revascularization procedures of the ICA were performed on the symptomatic patient. 26 of them fulfilled the prophylactic urgency criteria: symptoms of the cerebrovascular insufficiency and a string sign or ulcerative stenosis of the ICA with ulceration greater than 2 mm in depth. These results were compared to the control group of the 157 procedures under elective circumstances.
Results:
Mean clamping time of the urgency and the elective patients were 23.8 min vs. 24.5 min and operation time 50.1 min vs. 54.3 min. None of our urgency patients presented new neurological defects in the postoperative phase, while this occurred in 3.8% in the elective group. Mortality rate in the elective group was 2.7% and 0% in the urgency group. Furthermore, there were fewer local complications in the urgency group.
Conclusion:
The urgent indication for the desobliteration of the ICA showing a symptomatic string sign or ulcerative stenosis can be recommended. Early thrombosis or neurological defects during the waiting period may be prevented without increasing complication rates.
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