title: Is early surgical revascularization of symptomatic carotid stenoses safe?
abstract: BACKGROUND
  The objective of this exploratory study was to determine the rate of the complications of early surgery for symptomatic carotid stenosis, in 2 centers of Western France.
  
  
  METHODS
  Between January 2011 and January 2013, we prospectively enrolled all the patients admitted for transient ischemic accident (TIA) or minor stroke (Rankin ≤ 3) associated with an ipsilateral carotid stenosis >50% (North American Symptomatic Carotid Endarterectomy Trial) and operated before the 14th day following the neurologic event at the University hospitals of Angers and Tours. The demographic data (gender, age, and medical history) and the characteristics of the procedures were recorded. The rates of stroke, TIA, and postoperative deaths defined the cumulative morbidity and mortality rate (CMMR) of the study.
  
  
  RESULTS
  Ninety-one patients were included in the study. They presented 27 TIAs and 64 strokes. The average elapsed time between the neurologic event and surgery was 9.8 days. During this time, 10 patients, that is, 11% of the operated cohort, presented a new ischemic neurologic event while waiting for surgery. Surgical operations consisted of 56 eversions (61.5%), 32 endarterectomies with patch (35.1%), 2 bypasses, and 1 direct closure. The CMMR reached 3.3%. Two patients presented with a stroke and 1 patient died of a cardiologic cause during the postoperative period.
  
  
  CONCLUSIONS
  This study confirms the interest of an early surgery for symptomatic carotid stenoses with a Rankin score of ≤3. The risk of recurrence of a cerebral ischemic accident during the preoperative period remains high.
authors: Unité de Chirurgie Vasculaire, Service de Chirurgie Thoracique, Cardiaque et Vasculaire, CHU de Tours, Hôpital Trousseau, Chambray-les-Tours, France. Electronic address: thierrymerlini@gmail.com.
authors: Thierry
authors: T
authors: Merlini
authors: Service de Chirurgie Vasculaire et Thoracique, CHU d'Angers, Angers, France.
authors: Matthieu
authors: M
authors: Péret
authors: Unité de Chirurgie Vasculaire, Service de Chirurgie Thoracique, Cardiaque et Vasculaire, CHU de Tours, Hôpital Trousseau, Chambray-les-Tours, France.
authors: Pierre
authors: P
authors: Lhommet
authors: Service de Neurologie, CHU de Tours, Hôpital Bretonneau, Tours, France.
authors: Séverine
authors: S
authors: Debiais
authors: Unité Neuro-Vasculaire, Service de Neurologie, CHU d'Angers, Angers, France.
authors: Guillaume
authors: G
authors: Marc
authors: Unité Neuro-Vasculaire, Service de Neurologie, CHU d'Angers, Angers, France.
authors: Sophie
authors: S
authors: Godard
authors: Unité de Chirurgie Vasculaire, Service de Chirurgie Thoracique, Cardiaque et Vasculaire, CHU de Tours, Hôpital Trousseau, Chambray-les-Tours, France.
authors: Robert
authors: R
authors: Martinez
authors: Service de Chirurgie Vasculaire et Thoracique, CHU d'Angers, Angers, France.
authors: Bernard
authors: B
authors: Enon
authors: Service de Chirurgie Vasculaire et Thoracique, CHU d'Angers, Angers, France.
authors: Jean
authors: J
authors: Picquet
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005602:France; D006784:Hospitals, Teaching; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality