Early carotid endarterectomy after non-disabling ischaemic stroke: adequate therapeutical option in selected patients.
OBJECTIVE
To evaluate neurological outcome and long-term results of early carotid endarterectomy (CEA) after non-disabling stroke.


METHODS
Retrospective study between 1980 and 1995 of 56 patients undergoing CEA within 4 weeks of a transient (n = 15) or a permanent non-disabling (n = 41) ischaemic stroke.


METHODS
Analyses of preoperative cerebral CT imaging, neurological outcome (mod. Rankin-scale) and long-term results (life-table analyses according to Kaplan-Meier).


RESULTS
Incidence of early CEA increased from 1.7% (27 out of 1636) in the period 1980-1993 to 7.8% (29 out of 374) between 1994 and 1995. CEA was indicated after a neurological plateau phase was established (median interval 14 days). Fifty-seven per cent of the CEA patients had a minor ischaemic infarction (area < 2 cm), 18% showed a large territorial ischaemic infarction (area 2-5 cm) in cerebral CT imaging. Two patients deteriorated postoperatively (minor stroke rate 4%) but no major stroke or death occurred. Life-table probability of stroke-free survival (mean follow-up 42.7 months) was 94%, 90% and 84%, respectively, after 1, 2 and 5 years. Kaplan-Meier survival rates were 96%, 91% and 86% after 1, 2 and 5 years.


CONCLUSIONS
Early CEA after non-disabling stroke is a safe procedure in selected patients.
Eckstein
H H
HH
Department of Surgery, Ruprecht-Karls University of Heidelberg, Germany.
Schumacher
H
H
Laubach
H
H
Ringleb
P
P
Forsting
M
M
Dörfler
A
A
Bardenheuer
H
H
Allenberg
J R
JR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000601:surgery; D002544:Cerebral Infarction / Q000209:etiology; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging / Q000601:surgery; D018572:Disease-Free Survival; D016894:Endarterectomy, Carotid; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000601:surgery*; D015993:Life Tables; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D018579:Patient Selection; D012189:Retrospective Studies; D012449:Safety; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome