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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Published on: January 18, 2018

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Thirty-day outcome of delayed versus early management of symptomatic carotid stenosis

Emilie Charmoille1, Vincenzo Brizzi2, Sandro Lepidi3

  • 1Vascular Surgery Department, Bordeaux University Hospital, Bordeaux, France; Bordeaux University, Bordeaux, France.

Annals of Vascular Surgery
|March 14, 2015
PubMed

Insights

Early carotid endarterectomy (CEA) in symptomatic patients showed similar 30-day stroke and death rates compared to delayed CEA. This suggests that reducing the time to revascularization does not negatively impact patient outcomes.

Area of Science:

  • Vascular Surgery
  • Neurology
  • Cardiology

Background:

  • Symptomatic carotid stenosis poses a significant risk of stroke.
  • Timely intervention is crucial, but optimal timing for carotid endarterectomy (CEA) remains debated.

Purpose of the Study:

  • To compare the clinical outcomes of early (<15 days) versus delayed CEA in patients presenting with symptomatic carotid stenosis.
  • To evaluate the impact of symptom-to-surgery time on postoperative morbidity and mortality.

Main Methods:

  • Retrospective review of 149 patients undergoing CEA for symptomatic carotid stenosis (January 2006 - May 2010).
  • Patients were categorized into early (<15 days) and delayed (>15 days) surgery groups based on symptom onset.
  • Analysis of 30-day postoperative mortality, stroke, and myocardial infarction (MI) rates.

Main Results:

  • 149 patients were analyzed; 62 underwent early CEA and 87 underwent delayed CEA.
  • Thirty-day combined stroke and death rates were 1.7% for early CEA and 3.5% for delayed CEA.
  • Thirty-day combined stroke, death, and MI rates were 1.7% for early CEA and 5.9% for delayed CEA.

Conclusions:

  • Early CEA (<15 days) achieved 30-day mortality and morbidity rates equivalent to delayed CEA.
  • Adherence to carotid revascularization guidelines regarding symptom-to-knife time did not significantly impact outcomes in this cohort.
  • These findings support the safety and efficacy of early surgical intervention for symptomatic carotid stenosis.
Abstract

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