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Pilot study of carotid surgery for acute stroke
G E Mead1, H Murray, A Farrell
1University Department of Surgery, University Hospital of South Manchester, UK.
The British Journal of Surgery
|July 1, 1997
Summary
Urgent carotid surgery for acute stroke may be feasible. A pilot study suggests focusing future trials on patients with partial anterior circulation infarcts to assess this intervention.
Area of Science:
- Neurology
- Vascular Surgery
- Clinical Trials
Background:
- Carotid endarterectomy is typically delayed post-stroke, risking progression or further events.
- A pilot randomized study investigated the feasibility of urgent carotid surgery for acute stroke.
Purpose of the Study:
- To assess the feasibility of conducting a definitive multicentre trial on urgent carotid surgery for acute stroke.
- To determine if immediate surgical intervention is viable for stroke patients.
Main Methods:
- Patients with acute stroke (<7 days) underwent Doppler ultrasonography for carotid stenosis assessment.
- Severe stenosis (70-99%) led to randomization for either urgent carotid surgery or best medical care.
- Inclusion criteria involved Oxfordshire Community Stroke Project classification and stenosis severity.
Main Results:
- 593 patients were assessed; 414 had acute stroke, with 380 probable cerebral infarctions.
- Severe carotid stenosis was most common in partial anterior circulation infarcts.
- Only 16 patients were eligible and consented to randomization for urgent surgery.
Conclusions:
- A definitive trial requires screening a large patient cohort.
- Future trials should concentrate on patients with partial anterior circulation infarcts for urgent carotid surgery evaluation.