Urgent carotid endarterectomy for crescendo transient ischemic attack

Area of Science:

• Vascular Surgery
• Neurology
• Cardiology

Background:

• Carotid endarterectomy (CEA) is standard for severe carotid stenosis to reduce stroke risk.
• Optimal timing of CEA for acute neurological symptoms like crescendo transient ischemic attack (TIA) is debated.
• This study compares urgent CEA (UCEA) with elective CEA (ECEA) for crescendo TIA patients.

Purpose of the Study:

• To evaluate the effectiveness of UCEA within 6 hours versus ECEA within 2 weeks in preventing recurrent stroke.
• To compare perioperative outcomes and long-term adverse events between UCEA and ECEA groups.

Main Methods:

• Retrospective analysis of 87 patients undergoing UCEA and 174 matched controls undergoing ECEA for symptomatic carotid disease.
• Preoperative multidetector computed tomography angiography was performed for all patients.
• Primary outcomes included 30-day and 6-month mortality, stroke, TIA, and major adverse cardiac events.

Main Results:

• No postoperative strokes or TIAs occurred in the UCEA group; one stroke with full recovery occurred within 6 months.
• The ECEA group experienced one stroke and one death.
• UCEA group had higher overall mortality (4.6% vs. 0.6%; p=0.044), primarily due to myocardial infarction, with comparable early postoperative complications and restenosis rates.

Conclusions:

• UCEA within 6 hours of crescendo TIA demonstrates comparable perioperative outcomes to ECEA in preventing recurrent strokes.
• Early intervention with UCEA may be a viable option for crescendo TIA patients.
• Methodological limitations necessitate further research to definitively establish UCEA's safety and efficacy.