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Does Modified Rankin Score (mRS) Matter? The Impact of Stroke Severity on Carotid Artery Endarterectomy (CEA)
Lucinda Cruddas1, Daryll M Baker1
1Vascular Surgery, Royal Free Hospital, London, UK.
Insights
Carotid artery endarterectomy (CEA) is safe for patients with severe stroke (mRS≥3), showing similar short-term outcomes to those with milder strokes (mRS<3). Careful patient selection is still advised.
Area of Science:
- Vascular Surgery
- Neurology
- Neurosurgery
Background:
- Carotid artery endarterectomy (CEA) is standard for mild ischemic stroke (mRS<3).
- Outcomes of CEA in patients with more severe strokes (mRS≥3) are less understood.
Conclusions:
- Despite higher comorbidities, patients with mRS ≥3 experience similar short-term perioperative complication rates after CEA.
- CEA may be a viable option for selected patients with more severe strokes.
- Careful patient selection is crucial for optimizing CEA outcomes.
Background:
Carotid artery endarterectomy (CEA) is recommended to reduce stroke risk in patients following nondisabling ischemic stroke (modified Rankin Score mRS<3). We reviewed CEA outcomes in patients after more devastating strokes (mRS≥3).
Methods:
An observational cohort study was performed, and data were collected from 1013 CEA cases over 15 years. Patient demographics, comorbidities and postoperative outcomes were compared between preoperative mRS<3 (Group 1) and mRS≥3 (Group 2). Statistical significance was determined by P < 0.05.
Results:
Ninety-one (9%) patients were mRS ≥3. There was no significant difference between age, gender, and operated side. Group 2 had significantly higher rates of diabetes and frailty. There was no significant difference in anesthetic type. Group 2 spent longer in High Dependency. Return to theater and postoperative complications were similar. Incidence of perioperative stroke, mortality, and readmission rates were not significant at 30 days postoperation between the 2 groups.
Conclusions:
Patients with a higher mRS have more preoperative comorbidities but short-term perioperative complication rate is not significantly different. Patient selection should be undertaken with care.
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