Timing of carotid endarterectomy in patients with recent stroke.
BACKGROUND
There is little objective data to support the conventional wisdom of waiting 4 to 6 weeks after stroke to improve surgical outcome of subsequent carotid endarterectomy (CEA). We have aggressively pursued CEA in patients after recent stroke; in this study we report our results.


METHODS
We performed 215 CEA procedures in 200 patients who presented with an indication of stroke within 6 months of CEA. Cervical block anesthesia was used 193 cases. The rest were performed with the patient under general anesthesia.


RESULTS
Perioperative stroke rate was 1.4% (3/215), and operative mortality was 2% (4/200) (stroke mortality = 3.4%). There were four early occlusions. Shunts were used in 13.9%, patch closure in 8.4%, and eversion endarterectomy in 48% of cases. There was no correlation between timing of surgery, extent of infarct on computed tomography/magnetic resonance imaging, and postoperative neurologic complications with the occurrence of postoperative stroke (p = NS). During the same period, 1,922 patients underwent CEA for indications other than stroke, with a perioperative stroke rate and mortality rate of 1.1%.


CONCLUSIONS
Selected patients presenting with a history of stroke and significant carotid artery disease can safely undergo early CEA with a mortality and morbidity comparable to patients undergoing CEA for other indications.
Paty
P S
PS
Vascular Surgery Section, Albany Medical College, N.Y. 12208, USA.
Darling
R C
RC
Woratyla
S
S
Chang
B B
BB
Kreienberg
P B
PB
Shah
D M
DM
D016893:Carotid Stenosis / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000379:methods / Q000401:mortality; D005260:Female; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D008499:Medical Records; D009017:Morbidity; D009518:New York; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors