Carotid surgery in acute symptomatic patients

Area of Science:

• Vascular Surgery
• Neurology
• Diagnostic Imaging

Background:

• Symptomatic extracranial carotid artery disease poses a significant stroke risk.
• Urgent surgical intervention is considered for select high-risk patients.
• Evolving diagnostic techniques influence surgical decision-making.

Purpose of the Study:

• To evaluate the efficacy and outcomes of urgent carotid artery surgery.
• To assess the impact of new diagnostic techniques on patient selection.
• To analyze changing surgical considerations in a university hospital setting.

Main Methods:

• Prospective monitoring of 67 patients undergoing urgent carotid surgery.
• Diagnosis confirmed by duplex sonography and assessment of middle cerebral artery (MCA) patency.
• Intracerebral damage evaluated using CT or MR imaging.
• Standardized perioperative and surgical management.
• Neurological status assessed using the Rankin scale.

Main Results:

• 67 symptomatic patients (58% stroke, 42% TIA) underwent surgery within a median of 2 days.
• Successful revascularization achieved in 93% of internal carotid artery (ICA) cases.
• Thirty-day mortality was 3%, with 13% disease-related morbidity.
• One and two-year survival rates were 92% and 90%, respectively.
• No ipsilateral recurrent strokes were observed during follow-up.

Conclusions:

• Stratified diagnostic workup using advanced imaging techniques aids patient selection.
• Urgent carotid surgery can be beneficial for carefully selected patients.
• This approach may offer advantages over conservative management for specific cases.