The value of urgent carotid surgery for crescendo transient ischemic attacks.
OBJECTIVE
This study audited operative risk in patients undergoing urgent carotid surgery for crescendo transient ischemic attacks (TIAs).


METHODS
Interrogation of the vascular unit database (January 1992 to July 2004) identified 42 patients operated on urgently for crescendo TIAs, which were defined as>or=3 TIAs within the preceding 7 days. Stroke, death, and any major cardiac events were analyzed.


RESULTS
Thirty-nine patients underwent conventional endarterectomy, and three underwent interposition vein bypass. Crescendo TIA patients had sustained a median of five TIAs (range, 3 to 20) in the 7 days before surgery. Three patients died or had a stroke after surgery, for a combined stroke/death rate of 7%. This compares with 2.4% in 1000 patients undergoing elective carotid endarterectomy in this unit during the same time period. The combined stroke/death/major cardiac event rate was 14% (n=6).


CONCLUSIONS
The combined risk of neurologic and cardiac complications after urgent carotid surgery for crescendo TIA is higher than that expected after elective cases but is still acceptable considering the natural history of patients with unstable neurologic symptoms.
Karkos
Christos D
CD
Department of Vascular and Endovascular Surgery, Leicester Royal Infirmary, Leicester, United Kingdom. ckarkos@hotmail.com
McMahon
Greg
G
McCarthy
Mark J
MJ
Dennis
Martin J
MJ
Sayers
Robert D
RD
London
Nicholas J M
NJ
Naylor
A Ross
AR
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D002343:Carotid Artery, Internal / Q000601:surgery*; D019992:Databases as Topic; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008297:Male; D008485:Medical Audit / Q000706:statistics & numerical data; D008875:Middle Aged; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D012501:Saphenous Vein / Q000637:transplantation*; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology