The importance of early carotid endarterectomy in symptomatic patients.
BACKGROUND
Early carotid endarterectomy (CEA) in symptomatic patients may prevent repeat cerebral events. This study investigates the relationship between waiting time for CEA and the incidence of repeat cerebral events prior to surgery in symptomatic patients.


METHODS
A prospective database of consecutive patients undergoing CEA between January 2002 and December 2006 was reviewed. Repeat event rates prior to surgery were calculated using Kaplan-Meier analysis and predictive factors identified using Cox regression analysis.


RESULTS
A total of 118 patients underwent CEA for non-disabling stroke, TIA and amaurosis fugax. Repeat cerebral events occurred in 34 of 118 (29%) patients at a median 51 days (range, 2-360 days) after the first event. The estimated risk of repeat events was 2% at 7 days and 9% at 1 month after first event (Kaplan-Meier survival analysis). Age (HR 1.059; 95% CI 1.014-1.106; P = 0.009] was identified as a predictor of repeat events. Patients underwent surgery at median 97 days (range, 7-621 days) after the first event. Eleven of 60 (18%) patients waiting < or = 97 days for surgery and 23 of 58 (40%) patients waiting > 97 days had repeat events. (P = 0.011, chi-squared test).


CONCLUSIONS
Delays in surgery should be reduced in order to minimise repeat cerebral events in patients with symptomatic carotid stenosis, particularly in the elderly population.
Kulkarni
S R
SR
Department of Vascular Surgery, Cheltenham General Hospital, UK.
Gohel
M S
MS
Bulbulia
R A
RA
Whyman
M R
MR
Poskitt
K R
KR
D000368:Aged; D000369:Aged, 80 and over; D020757:Amaurosis Fugax / Q000517:prevention & control*; D016893:Carotid Stenosis / Q000601:surgery*; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000517:prevention & control*; D014850:Waiting Lists