title: Very urgent carotid endarterectomy confers increased procedural risk.
abstract: OBJECTIVE
  Current Swedish guidelines recommend that carotid endarterectomy should be performed within 14 days of a qualifying neurological event, but it is not clear if very urgent surgery after an event is associated with increased perioperative risk. The aim of this study was to determine how the time between the event and carotid endarterectomy affects the procedural risk of mortality and stroke.
  
  
  METHODS
  We prospectively analyzed data on all patients who underwent carotid endarterectomies for symptomatic carotid stenosis between May 12, 2008, and May 31, 2011, with records in the Swedish Vascular Registry (Swedvasc). Patients were divided according to time between the qualifying event and surgery (0-2 days, 3-7 days, 8-14 days, 15-180 days). Stroke rate and mortality at 30 days postsurgery were determined.
  
  
  RESULTS
  We analyzed data for 2596 patients and found that the combined mortality and stroke rate for patients treated 0 to 2 days after qualifying event was 11.5% (17 of 148) versus 3.6% (29 of 804), 4.0% (27 of 677), and 5.4% (52 of 967) for the groups treated at 3 to 7 days, 8 to 14 days, and 15 to 180 days, respectively. In a multivariate analysis, time was an independent risk factor for perioperative complications: patients treated at 0 to 2 days had a relative OR of 4.24 (CI, 2.07-8.70; P<0.001) compared with the reference 3- to 7-day group.
  
  
  CONCLUSIONS
  In this study of patients treated for symptomatic carotid disease, it was safe to perform surgery as early as Day 3 after a qualifying neurological event in contrast to patients treated within 0 to 2 days, which has a significantly increased perioperative risk.
authors.affiliation: Department of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden. sofia.stromberg@vgregion.se
authors.forename: Sofia
authors.initials: S
authors.lastname: Strömberg
authors.forename: Johan
authors.initials: J
authors.lastname: Gelin
authors.forename: Torun
authors.initials: T
authors.lastname: Osterberg
authors.forename: Göran M L
authors.initials: GM
authors.lastname: Bergström
authors.forename: Lars
authors.initials: L
authors.lastname: Karlström
authors.forename: Klas
authors.initials: K
authors.lastname: Osterberg
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D016893:Carotid Stenosis / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*; D015996:Survival Rate; D013548:Sweden; D013997:Time Factors