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A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis
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Editor's Choice - Timing of Carotid Intervention in Symptomatic Carotid Artery Stenosis: A Systematic Review and

Andreia Coelho1, João Peixoto2, Armando Mansilha3

  • 1Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário do Porto, Portugal; Department of Surgery and Physiology, Faculdade Medicina da Universidade do Porto, Portugal.

European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery
|December 26, 2021
PubMed

Insights

Carotid endarterectomy (CEA) is safer than carotid artery stenting (CAS) within 7 days of symptom onset. Expedited CEA meets international guidelines, while optimal CAS timing remains undefined.

Area of Science:

  • Vascular Surgery
  • Interventional Neurology
  • Clinical Outcomes Research

Background:

  • Timely intervention for symptomatic carotid artery stenosis is crucial for stroke prevention.
  • Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are primary revascularization strategies.
  • Optimal timing for these procedures relative to symptom onset is debated.

Purpose of the Study:

  • To analyze the timing of CEA and CAS after symptom onset.
  • To evaluate 30-day outcomes for CEA and CAS at varying time intervals within 14 days.
  • To compare the safety and efficacy of CEA versus CAS based on procedural timing.

Main Methods:

  • Systematic review adhering to PRISMA guidelines.
  • Searched Medline and Cochrane databases for relevant studies.
  • Included 71 studies with 232,952 symptomatic patients; assessed study quality.
  • Endpoints included procedural stroke and/or death, stratified by delay and technique (CEA/CAS).

Main Results:

  • CAS showed higher 30-day stroke and mortality rates compared to CEA when performed within 2 days of symptom onset.
  • Expedited CEA (≤2 days) showed no significant difference in 30-day stroke rates versus later intervention (3-14 days).
  • Expedited CAS (≤2 days) had similar stroke rates but significantly higher mortality compared to later intervention (3-14 days).

Conclusions:

  • Carotid endarterectomy (CEA) is safer than transfemoral CAS within the first 7 days of symptom onset.
  • Expedited CEA aligns with international guidelines regarding absolute stroke rates.
  • The optimal timing for CAS, when indicated over CEA, requires further definition and standardized reporting.
Abstract

Keywords:
Carotid stenosisDeathEndarterectomyStentStrokecarotid

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