Safety of early endarterectomy in patients with symptomatic carotid artery stenosis: an international multicenter study.
OBJECTIVE
Although the latest recommendations suggest that carotid endarterectomy (CEA) should be performed in symptomatic carotid artery stenosis (sCAS) patients within 2 weeks of the index event, only a minority of patients undergo surgery within the recommended time-frame. The aim of this international multicenter study was to prospectively evaluate the safety of early CEA in patients with sCAS in everyday clinical practice settings.


METHODS
Consecutive patients with non-disabling acute ischaemic stroke (AIS) or transient ischaemic attack (TIA) due to sCAS (≥ 70%) underwent early (≤ 14 days) CEA at five tertiary-care stroke centers during a 2-year period. Primary outcome events included stroke, myocardial infarction (MI) or death occurring during the 30-day follow-up period and were defined according to the International Carotid Stenting Study criteria.


RESULTS
A total of 165 patients with sCAS [mean age 69 ± 10 years; 69% men; 70% AIS; 6% crescendo TIA; 8% with contralateral internal carotid artery (ICA) occlusion] underwent early CEA (median elapsed time from symptom onset 8 days). Urgent CEA (≤ 2 days) was performed in 20 cases (12%). The primary outcomes of stroke and MI were 4.8% [95% confidence interval (CI) 1.5%-8.1%] and 0.6% (95% CI 0%-1.8%). The combined outcome event of non-fatal stroke, non-fatal MI or death was 5.5% (95% CI 2.0%-9.0%). Crescendo TIA, contralateral ICA occlusion and urgent CEA were not associated (P > 0.2) with a higher 30-day stroke rate.


CONCLUSIONS
Our findings indicate that the risk of early CEA in consecutive unselected patients with non-disabling AIS or TIA due to sCAS is acceptable when the procedure is performed within 2 weeks (or even within 2 days) from symptom onset.
Second Department of Neurology, 'Attikon' Hospital, University of Athens, School of Medicine, Athens, Greece; Department of Neurology, Democritus University of Thrace, School of Medicine, Alexandroupolis, Greece; International Clinical Research Center, St Anne's University Hospital in Brno, Brno, Czech Republic.
G
G
Tsivgoulis
C
C
Krogias
G S
GS
Georgiadis
R
R
Mikulik
A
A
Safouris
S H
SH
Meves
K
K
Voumvourakis
M
M
Haršány
R
R
Staffa
S G
SG
Papageorgiou
A H
AH
Katsanos
A
A
Lazaris
A
A
Mumme
M
M
Lazarides
S N
SN
Vasdekis
D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000592:standards*; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
carotid artery; carotid endarterectomy; early; stroke