title: Carotid endarterectomy within seven days after the neurological index event is safe and effective in stroke prevention.
abstract: BACKGROUND
  Timing of surgery remains a controversial subject with some concerns persisting that the benefit of early carotid endarterectomy (CEA) offsets the perioperative risks. We investigated the neurological outcome of patients with symptomatic internal carotid artery (ICA) stenosis after surgery in relation to the timing of treatment.
  
  
  METHODS
  From January 2005 to June 2010, 468 patients (n = 349 male, 74.6%, median age 71 years) underwent CEA for symptomatic stenosis. Perioperative morbidity and mortality rates were assessed in the 30 days' follow-up.
  
  
  RESULTS
  The median time interval between index event and CEA was 7 days; the overall stroke and death rate reached 3.4%. There was no difference in the 30 days' rate of stroke /death rate, depending on the timing of surgery (n = 5/241, 2.1% in patients treated within 1 week vs. n = 10/215, 4.7% in patients treated thereafter, p = 0.12). Patients with a postoperative neurological deterioration had more often an ischaemic infarction on preoperative cerebral computed tomography (CCT) compared with those without deterioration (n = 6/15, 40.0% vs. n = 39/441, 9.0%, p = 0.003). Logistic regression analysis showed that patients with preoperative infarction on CCT had the highest risk for postoperative neurological deterioration.
  
  
  CONCLUSIONS
  An infarction on the preoperative CCT leads to an increased risk for a postoperative deterioration after CEA. Patients should be treated at an early point in time with bland CCTs.
authors: Department of Vascular Surgery, Innsbruck Medical University, Austria. barbara.rantner@i-med.ac.at
authors: B
authors: B
authors: Rantner
authors: B
authors: B
authors: Kollerits
authors: C
authors: C
authors: Schmidauer
authors: J
authors: J
authors: Willeit
authors: M
authors: M
authors: Thauerer
authors: M
authors: M
authors: Rieger
authors: G
authors: G
authors: Fraedrich
mesh_terms: D000368:Aged; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D002544:Cerebral Infarction / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control; D018450:Disease Progression; D016894:Endarterectomy, Carotid; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control*; D015996:Survival Rate