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Early versus delayed carotid endarterectomy after a nondisabling ischemic stroke: a prospective randomized study
Enzo Ballotta1, Giuseppe Da Giau, Claudio Baracchini
1Section of Vascular Surgery, the 1st Medical Clinic of the Department of Medical and Surgical Sciences, and the Department of Neurologic Sciences, University of Padua, School of Medicine, Padua, Italy.
Surgery
|March 15, 2002
Summary
Early carotid endarterectomy (CEA) after a minor stroke is safe. The study found no significant difference in stroke or death rates between early and delayed CEA, suggesting timing doesn't impact benefits.
Area of Science:
- Vascular Surgery
- Neurology
- Clinical Trials
Background:
- Optimal timing for carotid endarterectomy (CEA) after minor stroke remains uncertain.
- Previous studies offer limited prospective data on early vs. delayed CEA.
- Nondisabling ischemic stroke is defined as a stabilized deficit not impacting daily activities.
Purpose of the Study:
- To prospectively compare perioperative death and stroke rates of early (within 30 days) versus delayed (after 30 days) CEA.
- To evaluate the safety and efficacy of CEA timing after nondisabling ischemic stroke.
Main Methods:
- Prospective randomized trial of 86 patients with minor stroke and carotid bifurcation disease.
- 45 patients underwent early CEA, 41 underwent delayed CEA.
- All patients had preoperative imaging; CEAs were performed using eversion technique with continuous monitoring.
Main Results:
- No perioperative deaths in either group.
- Comparable perioperative stroke rates: 2% in the early group and 2% in the delayed group.
- Similar survival rates at 1, 2, and 3 years (mean follow-up 23 months).
Conclusions:
- Early CEA after nondisabling ischemic stroke is safe.
- Perioperative mortality and stroke rates are comparable between early and delayed CEA.
- Surgical timing does not appear to influence the overall benefit of CEA.