Early carotid surgery in acute stroke: a multicentre randomised pilot study.
BACKGROUND
Standard practice has been to delay carotid endarterectomy (CEA) for 2 months following acute stroke to avoid a perceived risk of cerebral haemorrhage. We investigated whether early CEA reduces early recurrent stroke and improves outcome in partial anterior circulation infarction (PACI).


METHODS
Patients with PACI and a Barthel score of >18 before stroke underwent carotid duplex and CT imaging within 7 days of stroke. Forty consenting patients fit for surgery with greater than 70% ipsilateral carotid stenosis were randomised, 19 to 'early' (within 24 h) and 21 to 'delayed' surgery (at 8 weeks). Modified Rankin and Barthel scores were recorded at 1 week, 2 months, 6 and 12 months.


RESULTS
Rankin scores improved more rapidly following 'early' surgery to a score of 1 (0-4) at 2 and 6 months compared with 2.5 and 2 (1-4), respectively, for delayed surgery (p < 0.05). Barthel scores were also significantly improved following 'early' CEA at 7 days but both groups reached a median score of 20 by 2 months. Four 'delayed' and 3 'early' patients suffered extension or recurrence of neurological deficits with 1 death in each group.


CONCLUSIONS
Early CEA within 7 days of ischaemic stroke improved functional outcome with earlier hospital discharge. A large multicentre study is needed to exclude the possibility that 'early' CEA increases the risk of cerebral haemorrhage or death.
Welsh
S
S
University Hospital of South Manchester and University Department of Surgery, Manchester, UK.
Mead
G
G
Chant
H
H
Picton
A
A
O'Neill
P A
PA
McCollum
C N
CN
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009420:Nervous System / Q000503:physiopathology; D010865:Pilot Projects; D011184:Postoperative Period; D020521:Stroke / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome