Early carotid surgery in acute stroke: a multicentre randomised pilot study.

Area of Science:

• Neurology
• Vascular Surgery
• Stroke Medicine

Background:

• Standard practice delays carotid endarterectomy (CEA) for 2 months post-stroke due to hemorrhage concerns.
• Partial anterior circulation infarction (PACI) patients with significant carotid stenosis are candidates for CEA.
• The study investigates the safety and efficacy of early CEA in PACI patients.

Purpose of the Study:

• To determine if early CEA reduces recurrent stroke risk in PACI patients.
• To assess if early CEA improves functional outcomes compared to delayed surgery.
• To evaluate the impact of early CEA on hospital discharge timing.

Main Methods:

• Forty PACI patients with >70% ipsilateral carotid stenosis and good pre-stroke function were randomized.
• Early surgery group (19 patients) underwent CEA within 24 hours.
• Delayed surgery group (21 patients) underwent CEA at 8 weeks; functional outcomes were assessed using modified Rankin and Barthel scores.

Main Results:

• Early CEA group showed significantly faster improvement in Rankin scores at 2 and 6 months.
• Barthel scores improved significantly at 7 days in the early CEA group.
• Neurological deficits occurred in 4 delayed and 3 early surgery patients; one death in each group.

Conclusions:

• Early CEA (within 7 days) improves functional outcomes and facilitates earlier hospital discharge in PACI patients.
• The study suggests early CEA is beneficial but requires larger trials to definitively assess cerebral hemorrhage risk.
• Further multicenter studies are recommended to confirm the safety profile of early CEA.