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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
09:21

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

Delay from symptoms to carotid endarterectomy

E P Johansson1, P Wester

  • 1Department of Public Health and Clinical Medicine, Umeå Stroke Centre, Norrlands University Hospital, Umeå, Sweden. elias.johansson@medicin.umu.se

Journal of Internal Medicine
|February 13, 2008
PubMed

Insights

Delays in carotid endarterectomy (CEA) for symptomatic carotid stenosis led to significant risks. Many patients experienced additional cerebrovascular events before surgery, with risks comparable to perioperative complications.

Area of Science:

  • Neurology
  • Vascular Surgery
  • Public Health

Background:

  • Symptomatic carotid stenosis poses a significant risk of stroke.
  • Carotid endarterectomy (CEA) is a crucial intervention for reducing this risk.
  • Timely intervention is critical to prevent further cerebrovascular events.

Purpose of the Study:

  • To evaluate the time interval between cerebrovascular symptoms and CEA.
  • To identify factors contributing to delays in CEA.
  • To assess the occurrence of additional cerebrovascular events before CEA.

Main Methods:

  • Observational, single-center study.
  • Included 275 patients with symptomatic carotid stenosis (>=50%) between 2004 and 2006.
  • Analyzed time from symptom onset to CEA, and incidence of pre- and perioperative cerebrovascular events.

Main Results:

  • Median time from symptom to CEA was 11.7 weeks, decreasing to 6.9 weeks by study end.
  • Only 7% of patients received CEA within 2 weeks of symptom onset.
  • 28% of patients experienced additional cerebrovascular events before CEA; 1.4% had strokes precluding surgery.

Conclusions:

  • Substantial delays exist between cerebrovascular symptom onset and CEA, exceeding the recommended 2-week timeframe.
  • A significant proportion of patients suffer additional cerebrovascular events prior to CEA.
  • The risk of a severe stroke before CEA is comparable to the risk of severe complications from the procedure.
Abstract

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