Early Carotid Endarterectomy Provides a Better Neurological Outcome in Symptomatic Patients: A Single-Center Experience
Gianfranco Varetto1, Lorenzo Gibello1, Francesca Sperti1
1Division of Vascular Surgery, Department of Surgical Sciences, University of Turin, Azienda Ospedaliera Universitaria Città della Salute e delle Scienza, Torino, Italy.
Insights
Early carotid endarterectomy (CEA) significantly improves neurological outcomes for symptomatic carotid stenosis patients. Prompt surgical intervention, ideally within two weeks, leads to better recovery and reduced impairment compared to delayed procedures.
Area of Science:
- Vascular Surgery
- Neurology
- Stroke Prevention
Background:
- Carotid endarterectomy (CEA) is established for preventing recurrent stroke.
- Mid-to-long-term neurological benefits of early CEA require further investigation.
- Symptomatic carotid stenosis poses a risk for stroke and transient ischemic attack (TIA).
Purpose of the Study:
- To evaluate the impact of early CEA on perioperative and postoperative complications.
- To assess the neurological benefit of early CEA in patients with symptomatic carotid stenosis.
- To determine the correlation between time to surgery and patient outcomes.
Main Methods:
- Ninety patients with symptomatic carotid stenosis were divided into two groups: early surgery (within 2 weeks) and delayed surgery (after 2 weeks).
- Neurological status was assessed using the National Institutes of Health Stroke Scale (NIHSS).
- Follow-up included Echo color Doppler ultrasound at 1-6 months and annually thereafter.
Main Results:
- A significant improvement in neurological impairment (reduced NIHSS score) was observed in the early surgery group (G1) compared to the delayed group (G2).
- No significant differences in surgical intervention or perioperative complications were found between the groups.
- Symptom presentation varied, with minor stroke more common in the early group and TIA in the delayed group.
Conclusions:
- Time to surgery is a critical factor influencing neurological recovery in symptomatic carotid stenosis.
- Early recognition of symptoms and prompt surgical intervention (CEA) are crucial for improving patient outcomes.
- Enhanced collaboration between the general population, referring physicians, and neurologists is essential to reduce delays in CEA.
Background:
Many studies confirmed the role of early carotid endarterectomy (CEA) to prevent recurrent stroke or transient ischemic attack; however, the mid-long-term neurological benefit is still not completely investigated. The purpose of the study was to evaluate the role of early CEA on the perioperative and postoperative stroke/death complications of patients with a symptomatic carotid stenosis.
Methods:
Ninety consecutive patients were referred to our center for a symptomatic carotid stenosis. They were divided into 2 groups according to the time to surgery: G1 within 2 weeks (39 patients) and G2 from 2 weeks to thereafter (51 patients). Neurological assessment was performed with the National Institutes of Health Stroke Scale (NIHSS) at presentation and at follow-up. Echo color Doppler ultrasound was performed at 1-6 months and then yearly.
Results:
The presentation of neurological symptoms differed significantly between the 2 groups; in fact, minor stroke was more frequent in G1, whereas transient ischemic attack was more frequent in G2 (P value = 0.027). No significant differences emerged between the 2 groups on the surgical intervention or perioperative complications. The study showed a significant improvement of the neurological impairment (evaluated with a reduction of NIHSS score) of patients in G1 compared with G2 (P value = 0.01).
Conclusions:
Neurological recovery after a symptomatic carotid stenosis is strictly correlated to the variable "time to surgery." A higher sensitization of the general population on the early recognition of the symptoms and a strict collaboration with neurologists is mandatory to reduce time to CEA and improve clinical outcomes.
