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Carotid endarterectomy after a completed stroke: reduction in long-term neurologic deterioration
Insights
Carotid endarterectomy significantly reduces recurrent stroke in patients with fixed neurologic deficits. This surgical intervention protected operated patients from new deficits, unlike the unoperated group.
Area of Science:
- Neurology
- Vascular Surgery
- Stroke Medicine
Background:
- The efficacy of carotid endarterectomy (CEA) in patients with prior completed stroke is debated.
- 118 patients with permanent neurologic deficits post-stroke were studied.
Purpose of the Study:
- To evaluate the long-term benefits of CEA in stroke patients with carotid lesions.
- To determine if CEA reduces recurrent neurologic deficits and stroke-related mortality.
Main Methods:
- A retrospective study comparing 59 patients managed nonoperatively with 59 undergoing CEA.
- Long-term follow-up assessed survival, new neurologic deficits, and stroke-related deaths.
Main Results:
- Overall survival rates were similar between medical and surgical cohorts (9 vs. 8 deaths).
- Significantly fewer new neurologic deficits occurred in the surgical group (2/59) compared to the medical group (12/59).
- At 6 years, 100% of operated patients were free from recurrent deficits, versus 58% of unoperated patients (p=0.02).
Conclusions:
- Carotid endarterectomy may protect stroke patients with fixed mild to moderate deficits and carotid lesions from recurrent complications.
- CEA demonstrated a significant reduction in recurrent neurologic deficits and stroke-related mortality.
Abstract:
The merit of carotid endarterectomy for patients who previously have sustained a completed stroke remains controversial. Between January 1976 and December 1983, 118 stroke patients with mild to severe permanent neurologic deficits were evaluated. Fifty-nine patients were managed nonoperatively and 59 operatively. Both cohorts were similar in age and sex distribution, incidence of hypertension (69%), diabetes mellitus (25%), and cardiac disease (39%). In the long-term follow-up (medical cohort average was 44.1 +/- 5.0 months; surgical cohort average, 41.8 +/- 3.7 months) the overall survival rate was comparable, that is, there were nine medical deaths and eight surgical deaths. However, there was a significant difference in the development of new neurologic deficits. Twelve of the 59 unoperated patients had new neurologic deficits and three patients died at 12, 36, and 48 months as a result of a recurrent stroke. New neurologic deficits developed in only two of the 59 surgical patients and there were no stroke-related deaths. When the cumulative probability of remaining free from recurrent deficits was examined in the surviving patients at 6 years, all of the patients in the operated group remained free from recurrent deficits, whereas only 58% of the patients in the unoperated group were free of new neurologic deficits (p = 0.02). These data suggest that stroke patients with fixed mild to moderate neurologic deficits and with carotid lesions may be protected from recurrent neurologic complications by carotid endarterectomy.