Carotid endarterectomy within 2 weeks of minor ischemic stroke: a prospective study.
OBJECTIVE
Data from multicenter symptomatic trials have shown that benefit from carotid endarterectomy (CEA) was greatest in patients with carotid disease operated within 2 weeks of their last ischemic event. We prospectively analyzed the safety and benefit of CEA performed within 2 weeks of a stroke.


METHODS
The study involved patients with acute minor stroke admitted to two stroke units who underwent CEA within 2 weeks of their last ischemic event, once they were considered neurologically stable. Preoperative workup included scoring ischemia-related symptoms according to a modified ranking scale (mRS), carotid duplex scan, transcranial Doppler ultrasound, and head computed tomography or magnetic resonance imaging. All patients underwent neurological assessment on admission, 1 day before and 2 days after CEA, and at discharge. A complete neurological and ultrasound follow-up was performed at 1, 6, and 12 months after CEA, then yearly. All procedures were eversion CEA under deep general anesthesia, with selective shunting. Endpoints were perioperative (30-day) stroke/mortality rate or cerebral bleeding and long-term stroke recurrence or cerebral hemorrhage.


RESULTS
Between 2000 and 2005, 102 patients with a mRS </= 2 underwent CEA within a median 8 days of acute ischemic stroke. Shunting and contralateral carotid occlusion were found significantly correlated. There were no perioperative strokes or deaths, or cerebral hemorrhage. All patients were followed up for a mean 34 months (range 1-66) with no recurrent stroke or cerebral bleeding.


CONCLUSIONS
CEA can be performed within 2 weeks of carotid-related ischemic stroke with no perioperative stroke or cerebral bleeding, preventing the risk of stroke recurrence.
Ballotta
Enzo
E
Department of Surgical and Gastroenterological Sciences, Vascular Surgery Section of the Geriatric Surgery Clinic, University of Padua, Padova, Italy. enzo.ballotta@unipd.it
Meneghetti
Giorgio
G
Da Giau
Giuseppe
G
Manara
Renzo
R
Saladini
Marina
M
Baracchini
Claudio
C
D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D016893:Carotid Stenosis / Q000150:complications / Q000473:pathology / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000517:prevention & control; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055502:Secondary Prevention; D020521:Stroke / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome