Carotid endarterectomy after recent cerebral infarction.
OBJECTIVE
whether timing of carotid endarterectomy (CEA) was significant in terms of morbidity and mortality for significant carotid stenosis. DESIGN/MATERIALS: comparison was made of patients requiring CEA performed in less than 6 weeks or more than 6 weeks after their stroke. To enable quantification in terms of clinical presentation, aetiology and handicap, standardised scales were incorporated into the registry protocol. A postoperative event was considered to have occurred if a stroke or death from any cause took place within one month of surgery.


RESULTS
patients with CEA (n=1005) and stroke numbered 232. Comparison was made of the early (n=86) and late surgery groups (n=121) in terms of demography, risk factors, clinical findings, quantitative neurological deficit, handicap and degree of carotid stenosis with no significant differences found except for race. There was no difference in morbidity and mortality (M+M) between the early and late surgery group. The relative risk (RR) of >6 week group was 1.90 (CI: 0.52-6. 94) with an odds ratio of 1.96 (CI: 0.45-9.63). There is, therefore, a trend of a two-fold risk of MM in the >6 week group.


CONCLUSIONS
we propose that the historical 6-week wait period for CEA post stroke is outdated.
Hoffmann
M
M
Department of Neurology, Durban Cerebrovascular Group, University of Natal, Durban, South Africa.
Robbs
J
J
D000368:Aged; D016893:Carotid Stenosis / Q000601:surgery*; D002544:Cerebral Infarction / Q000150:complications*; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome