title: Emergency carotid endarterectomy.
abstract: 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.
authors.affiliation: Department of Surgery, Division of Vascular Surgery, University of Heidelberg Medical School, Heidelberg, Germany.
authors.forename: H H
authors.initials: HH
authors.lastname: Eckstein
authors.forename: H
authors.initials: H
authors.lastname: Schumacher
authors.forename: K
authors.initials: K
authors.lastname: Klemm
authors.forename: H
authors.initials: H
authors.lastname: Laubach
authors.forename: T
authors.initials: T
authors.lastname: Kraus
authors.forename: P
authors.initials: P
authors.lastname: Ringleb
authors.forename: A
authors.initials: A
authors.lastname: Dörfler
authors.forename: M
authors.initials: M
authors.lastname: Weigand
authors.forename: H
authors.initials: H
authors.lastname: Bardenheuer
authors.forename: J R
authors.initials: JR
authors.lastname: Allenberg
mesh_terms: 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