Emergency carotid endarterectomy.
OBJECTIVE
Evaluation of the therapeutical efficacy of emergency carotid endarterectomy (CEA) in neurologically unstable patients.


METHODS
Three groups of a consecutive series of 71 emergency CEAs performed from 1980 to July 1998 were classified: (1) acute onset of severe stroke (n = 16), (2) progressive stroke/stroke in evolution (n = 34), and (3) crescendo transient ischemic attacks (n = 21). Cerebral coma, cerebral haemorrhage, and major ischemic stroke established in cranial computed tomography scans were contraindications for surgery. The neurological outcome was assessed by the modified Rankin scale. Long-term survival and long-term stroke recurrences were analyzed.


RESULTS
The recovery/minor stroke rates (Rankin 0-3) in acute stroke, progressive stroke, and crescendo transient ischemic attacks were 56.3, 76.4 and 80.9%, respectively; the combined major stroke/mortality rates (Rankin 4-6) were 43.7, 23.6 and 19.1%, respectively. Intraoperative angiography in 39 patients detected early carotid reocclusions in 2 and intracranial embolism in 7 patients. Local application of thrombolytic agents (n = 5) may contribute to a better neurological outcome in emergency CEA. Life table probabilities of major strokefree survival were 74.5, 71.6, and 53.7% after 1, 2, and 5 years, respectively (including perioperative strokes). Life table probabilities to suffer no stroke recurrence during follow-up were 96.7, 96.7 and 85.3%, respectively (perioperative strokes excluded).


CONCLUSIONS
Emergency CEA may be worthwhile in selected patients. Completion angiography is mandatory. Emergency CEA should be included in therapeutic strategies for ischemic stroke.
Eckstein
H H
HH
Department of Surgery, Division of Vascular Surgery, University of Heidelberg Medical School, Heidelberg, Germany.
Schumacher
H
H
Klemm
K
K
Laubach
H
H
Kraus
T
T
Ringleb
P
P
Dörfler
A
A
Weigand
M
M
Bardenheuer
H
H
Allenberg
J R
JR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D004630:Emergencies; D016894:Endarterectomy, Carotid; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D012307:Risk Factors; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome