Risk of early carotid endarterectomy for symptomatic carotid stenosis
Waleed Brinjikji1, Alejandro A Rabinstein, Fredric B Meyer
1Mayo Medical School, Mayo Clinic, Rochester, Minn 55906, USA.
Insights
Early carotid endarterectomy (CEA) for symptomatic patients shows a slightly higher risk of stroke, myocardial infarction, or death. However, CEA is safe for properly selected symptomatic patients within two weeks of their event.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiology
Background:
- Carotid endarterectomy (CEA) is a procedure to prevent stroke.
- Timing of CEA after a symptomatic event is crucial for patient outcomes.
Purpose of the Study:
- To compare stroke, myocardial infarction, and death rates after early vs. late CEA in symptomatic patients.
- To evaluate outcomes in asymptomatic patients undergoing CEA.
Main Methods:
- Retrospective analysis of 525 CEAs from 2004-2009.
- Patients grouped into asymptomatic, symptomatic late (>2 weeks), and symptomatic early (≤2 weeks).
- Primary outcomes: 30-day postoperative stroke, myocardial infarction, or death.
Main Results:
- 1.8% primary outcomes in asymptomatic group, 1.0% in symptomatic late group, and 4.2% in symptomatic early group.
- No significant difference in primary outcomes among the three groups (P=0.17).
- No significant difference when comparing early and late symptomatic groups (P=0.24).
Conclusions:
- Perioperative risk is slightly elevated in symptomatic patients undergoing early CEA.
- CEA is a safe and acceptable procedure for carefully selected symptomatic patients within two weeks of their event.
Background And Purpose:
The purpose of this study was to determine and compare the rate of stroke, myocardial infarction, and death in patients undergoing early and late carotid endarterectomy (CEA) after a symptomatic event and in asymptomatic patients.
Methods:
We conducted a retrospective analysis of all CEAs performed in the Department of Neurosurgery between January 2004 and May 2009. Patients were divided into 3 groups: Group 1, asymptomatic patients; Group 2, symptomatic patients operated on >2 weeks after their transient ischemic attack or stroke; and Group 3, symptomatic patients operated on ≤2 weeks of their transient ischemic attack or stroke. Primary outcomes were any myocardial infarction, stroke, or death occurring within 30 days postoperatively. The secondary end point was transient ischemic attack within 30 days postoperatively.
Results:
Five hundred thirty-two CEAs were performed on 507 patients during the study period. Thirty-day follow-up was available for 500 patients with 525 CEAs. Groups 1, 2, and 3 consisted of 278, 105, and 142 CEAs, respectively. In total, 12 patients had primary outcomes. In Group 1, 5 patients had primary outcomes of stroke, myocardial infarction, or death (1.8%); in Group 2, 1 patient had primary outcomes (1.0%); and in Group 3, 6 patients had primary outcomes (4.2%). There was no significant difference in the rate of primary outcomes among the 3 groups (P=0.17) or when Groups 2 and 3 were compared (P=0.24).
Conclusions:
Although the perioperative risk of transient ischemic attacks, stroke, death, and myocardial infarction is slightly higher in symptomatic patients operated on early, CEA can be done with an acceptable risk in properly selected symptomatic patients within 2 weeks of their transient ischemic attack or stroke.
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