Low Risk of Neurological Recurrence while Awaiting Carotid Endarterectomy: Results From a Danish Multicentre Study

Area of Science:

• Vascular Surgery
• Neurology
• Clinical Outcomes

Background:

• Symptomatic carotid artery stenosis poses a risk of neurological recurrence.
• National guidelines recommend carotid endarterectomy (CEA) within 14 days for these patients.

Purpose of the Study:

• To assess the risk of ipsilateral neurological recurrence (NR) in patients awaiting CEA.
• To evaluate the adequacy of current 14-day CEA guidelines in contemporary practice.

Main Methods:

• Retrospective, multicentre observational cohort study.
• Included 1,125 patients scheduled for CEA between 2014-2018.
• Data sourced from Danish Vascular Registry and electronic medical records.

Main Results:

• A median delay of 11 days to CEA resulted in NR in 3.6% of patients.
• No deaths or major strokes occurred during the waiting period.
• 30-day post-operative risk of death or stroke was 2.7%, not correlated with surgery timing.

Conclusions:

• Very few neurological recurrences occurred within 14 days for patients awaiting CEA.
• Immediate best medical treatment (BMT) followed by early CEA is a reasonable approach.
• Urgency of CEA may be less critical with effective BMT in specialized units.