Early carotid endarterectomy in selected stroke patients.
Although there are several reports suggesting the safety of performing carotid endarterectomy (CE) within 4 weeks (early) of a nondisabling stroke, at many institutions it is not standard practice. Benefits of early surgery may include reduction in the number of strokes or carotid occlusions during the time between stroke and surgery, as well as a reduction in the cost of medical care due to the elimination of interval anticoagulation and close follow-up. This review examines the outcomes of early CE in selected patients after a nondisabling stroke. A total of 1065 CEs were performed between November 1991 and April 1998. Seventy-five patients were identified by computerized hospital record and office chart review as having CE after a nondisabling stroke. Criteria for early surgery included 1) nondisabling stroke ipsilateral to a carotid stenosis >50%, 2) neurological stability, and 3) no evidence of hemorrhagic stroke or significant cerebral edema by CT/MRI evaluation. This review suggests that early CE can be performed in selected patients with an acceptable perioperative morbidity and mortality.
Kahn
M B
MB
Division of Vascular Surgery, Thomas Jefferson University, Philadelphia, PA 10107, USA.
Patterson
H K
HK
Seltzer
J
J
Fitzpatrick
M
M
Smullens
S
S
Bell
R
R
DiMuzio
P
P
Carabasi
R A
RA
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000191:economics / Q000627:therapeutic use; D001929:Brain Edema / Q000175:diagnosis / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000517:prevention & control / Q000601:surgery; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000000981:diagnostic imaging; D002544:Cerebral Infarction / Q000175:diagnosis / Q000000981:diagnostic imaging; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000517:prevention & control; D016527:Drug Costs; D016894:Endarterectomy, Carotid / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D018579:Patient Selection; D011183:Postoperative Complications; D012189:Retrospective Studies; D012449:Safety; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000925:Anticoagulants