Early versus delayed carotid endarterectomy after a nondisabling ischemic stroke: a prospective randomized study.
BACKGROUND
Although many retrospective and a few prospective studies have analyzed the outcome of early and delayed carotid endarterectomy (CEA) after a recent minor or nondisabling stroke (ie, a minimal and stabilized focal neurologic deficit of acute onset persisting for more than 24 hours and not leading to a handicap or to a significant impairment of daily living activities), the optimal timing of surgery remains uncertain. The purpose of this study was to prospectively compare the perioperative death and stroke rates of CEA performed within 30 days (early group) or more than 30 days (delayed group) after a nondisabling ischemic stroke in patients with carotid bifurcation disease.


METHODS
During a 4-year period, of 86 patients experiencing a minor stroke, 45 were randomized to undergo early CEA and 41 to undergo delayed CEA. All patients underwent preoperative cerebral computed tomography, duplex ultrasonographic scanning and angiography of the supra-aortic trunks. All CEAs were carotid eversion endarterectomies and were performed by the same surgeon, using deep general anesthesia, with continuous electroencephalographic monitoring for the selective shunting. The perioperative death and stroke rates were compared between the 2 groups.


RESULTS
No perioperative deaths occurred in either group. No recurrent strokes occurred during the waiting period in the delayed group. The incidence of perioperative stroke was comparable in the 2 groups (1 of 45, 2% vs 1 of 41, 2%). The mean follow-up was 23 months (range, 6 to 50 months). Survival rates after 1, 2, and 3 years were similar in the 2 groups.


CONCLUSIONS
Early CEA after a nondisabling ischemic stroke can be performed safely with perioperative mortality and stroke rates comparable with those of delayed CEA. The timing of surgery does not seem to influence the benefit of the CEA.
Ballotta
Enzo
E
Section of Vascular Surgery, the 1st Medical Clinic of the Department of Medical and Surgical Sciences, and the Department of Neurologic Sciences, University of Padua, School of Medicine, Padua, Italy.
Da Giau
Giuseppe
G
Baracchini
Claudio
C
Abbruzzese
Elvira
E
Saladini
Marina
M
Meneghetti
Giorgio
G
D002545:Brain Ischemia / Q000150:complications*; D002339:Carotid Arteries / Q000601:surgery*; D004691:Endarterectomy; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome