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Immediate Carotid Endarterectomy Is Associated with Higher Risk in Symptomatic Patients

James C Andersen1, Kristyn A Mannoia1, Sharon C Kiang1

  • 1Division of Vascular Surgery, Loma Linda University Medical Center, Loma Linda, CA.

Annals of Vascular Surgery
|June 16, 2019
PubMed

Insights

Performing carotid endarterectomy (CEA) immediately after symptoms of carotid artery stenosis (Sx-CAS) increases stroke risk. Delaying CEA surgery to 3-14 days or longer reduces stroke and mortality rates, supporting avoidance of immediate procedures.

Area of Science:

  • Vascular Surgery
  • Neurology
  • Clinical Outcomes Research

Background:

  • Guidelines recommend carotid endarterectomy (CEA) for carotid artery stenosis (Sx-CAS) ≥50% within 14 days of symptoms.
  • Immediate CEA (within 48 hours) may increase perioperative stroke risk.
  • Evaluating the impact of surgical timing on Sx-CAS outcomes is crucial.

Purpose of the Study:

  • To assess the effect of timing of carotid endarterectomy (CEA) on perioperative outcomes in patients with symptomatic carotid artery stenosis (Sx-CAS).
  • To compare stroke, myocardial infarction (MI), and mortality rates based on CEA timing relative to symptom onset.

Main Methods:

  • Retrospective review of 2203 CEAs from the Southern California Vascular Outcomes Improvement Collaborative (SoCal VOICe) (2012-2018).
  • Symptomatic carotid artery stenosis (Sx-CAS) defined by ipsilateral symptoms within 6 months.
  • CEA timing categorized as immediate (0-2 days), early (3-14 days), or delayed (>14 days).

Main Results:

  • Of 436 Sx-CAS cases, 14% were immediate, 38% early, and 48% delayed.
  • The immediate CEA group had significantly higher stroke rates (8.2%) compared to early (3.0%) and delayed (0.96%) groups (P=0.009).
  • Combined stroke/MI/30-day mortality was highest in the immediate group (13.1%) versus early (6.0%) and delayed (3.3%) (P=0.001).

Conclusions:

  • Immediate CEA (within 2 days) for Sx-CAS is associated with increased stroke rates.
  • Delaying CEA to 3-14 days or longer is linked to decreased stroke and mortality.
  • Avoidance of immediate CEA is supported; standardization of timing is needed.
Abstract

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