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.
University Hospital of South Manchester and University Department of Surgery, Manchester, UK.
S
S
Welsh
G
G
Mead
H
H
Chant
A
A
Picton
P A
PA
O'Neill
C N
CN
McCollum
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