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Carotid endarterectomy after reversible ischemic neurologic deficit or stroke: is it of value?
D Rosenthal1, E Borrero, M D Clark
1Department of Vascular Surgery, Georgia Baptist Medical Center--Medical College of Georgia, Atlanta.
Insights
Carotid endarterectomy (CE) significantly reduces recurrent stroke risk in patients with reversible ischemic neurologic deficit (RIND) or stroke. While not improving overall survival, CE offers a twofold decrease in stroke-related deaths.
Area of Science:
- Neurology
- Vascular Surgery
Background:
- The efficacy of carotid endarterectomy (CE) for preventing recurrent stroke after reversible ischemic neurologic deficit (RIND) or stroke remains debated.
- Long-term benefits of CE require further investigation in carefully selected patient cohorts.
Purpose of the Study:
- To evaluate the long-term benefits and clinical value of carotid endarterectomy (CE) in patients who have experienced a RIND or stroke.
- To assess the impact of CE on recurrent stroke incidence and overall survival over a 10-year period.
Main Methods:
- A 10-year retrospective review of 253 patients with RIND or stroke and demonstrated carotid bifurcation disease.
- Patients underwent CT brain scans and arteriography; 151 patients received CE, while 102 served as a non-operated control group.
- Postoperative complications and long-term outcomes, including recurrent stroke and survival, were meticulously recorded.
Main Results:
- Postoperative complications for CE included 1% mortality, 4% stroke incidence, and 7% transient neurologic deficits.
- The cumulative incidence of recurrent stroke was significantly lower in the CE group (7%) compared to the control group (18%) (p < 0.05).
- While CE did not significantly improve long-term survival, it resulted in a more than twofold reduction in recurrent stroke as a cause of death.
Conclusions:
- Carotid endarterectomy is effective in significantly reducing the risk of recurrent stroke in patients with RIND or stroke.
- CE does not appear to improve overall long-term survival but substantially decreases stroke-related mortality.
- The procedure demonstrates considerable value in preventing future cerebrovascular events in appropriately selected patients.
Abstract:
The benefit of carotid endarterectomy (CE) in preventing recurrent stroke and improving survival in the patient who has sustained a reversible ischemic neurologic deficit (RIND) or stroke is still controversial. To determine the long-term benefits and value of CE in these patients, a 10-year review of 253 patients who suffered a RIND or stroke was conducted. All patients had CT brain scans, as well as arch, extracranial, and intracranial arteriography; any patients without demonstrated carotid bifurcation disease were excluded from the study. On the basis of clinical symptoms and CT scan findings, 66 patients were categorized as having sustained a RIND and 187 a stroke. One hundred fifty-one patients who suffered a RIND or stroke had CE, whereas 102 patients with RIND or stroke did not have CE and served as a control group. All endarterectomies were performed with a temporary indwelling shunt. Postoperative complications included two deaths (1%), six strokes (4%), and 10 transient neurologic deficits (7%). In follow-up extending to 10 years the cumulative incidence of recurrent stroke was only 7% (11 patients) in the operated group, whereas 18% of patients in the nonoperated control group (18) sustained a recurrent stroke (p less than 0.05). As anticipated, the leading cause of death during follow-up was cardiac related; although CE did not significantly improve long-term survival, there was more than a twofold decrease in the incidence of recurrent stroke as a cause of death in the group having CE.(ABSTRACT TRUNCATED AT 250 WORDS)