title: Short Time Interval Between Neurologic Event and Carotid Surgery Is Not Associated With an Increased Procedural Risk.
abstract: OBJECTIVE
  Guidelines recommend that carotid endarterectomy should be performed within 2 weeks in patients with a symptomatic carotid stenosis. Because a Swedish register study indicated that patients treated within the first days after a stroke or transient ischemic attack might have an increased perioperative stroke and mortality risk, this study aimed to find out whether these findings are also true under everyday conditions in Germany.
  
  
  METHODS
  Secondary data analysis including 56 336 elective carotid endarterectomy procedures performed for symptomatic carotid stenosis under everyday conditions between 2009 and 2014. The patient cohort was divided into 4 groups according to time interval between index event and surgery (I: 0-2, II: 3-7, III: 8-14, and IV: 14-180 days). Primary outcome was any in-hospital stroke or death. For risk-adjusted analyses, a multilevel multivariable regression model was used.
  
  
  RESULTS
  Mean patients' age was 71.1±9.6 years; 67.5% were men. Overall rate of any stroke or death was 2.5% (n=1434). Risk of any in-hospital stroke or death was 3.0% in group I, 2.5% in group II, 2.6% in group III, and 2.3% in group IV. Multivariable regression analysis revealed that the time interval was not significantly associated with the primary outcome.
  
  
  CONCLUSIONS
  The time interval between the index event and carotid endarterectomy was not associated with the risk of any in-hospital stroke or death in patients with symptomatic carotid stenosis in Germany. In clinically stable patients, carotid endarterectomy might, therefore, be performed safely as soon as possible after the neurological index event.
authors.affiliation: From the Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany (P.T., A.K., M.K., C.K., S.S., A.Z., H.-H.E.); AQUA - Institute for Applied Quality Improvement and Research in Health GmbH, Göttingen, Germany (T.K., T.B.); and Department for Vascular and Thoracic Surgery, Klinikum Karlsruhe, Academic Teaching Hospital University of Freiburg, Karlsruhe, Germany (M.S.).
authors.forename: Pavlos
authors.initials: P
authors.lastname: Tsantilas
authors.affiliation: From the Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany (P.T., A.K., M.K., C.K., S.S., A.Z., H.-H.E.); AQUA - Institute for Applied Quality Improvement and Research in Health GmbH, Göttingen, Germany (T.K., T.B.); and Department for Vascular and Thoracic Surgery, Klinikum Karlsruhe, Academic Teaching Hospital University of Freiburg, Karlsruhe, Germany (M.S.).
authors.forename: Andreas
authors.initials: A
authors.lastname: Kuehnl
authors.affiliation: From the Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany (P.T., A.K., M.K., C.K., S.S., A.Z., H.-H.E.); AQUA - Institute for Applied Quality Improvement and Research in Health GmbH, Göttingen, Germany (T.K., T.B.); and Department for Vascular and Thoracic Surgery, Klinikum Karlsruhe, Academic Teaching Hospital University of Freiburg, Karlsruhe, Germany (M.S.).
authors.forename: Thomas
authors.initials: T
authors.lastname: König
authors.affiliation: From the Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany (P.T., A.K., M.K., C.K., S.S., A.Z., H.-H.E.); AQUA - Institute for Applied Quality Improvement and Research in Health GmbH, Göttingen, Germany (T.K., T.B.); and Department for Vascular and Thoracic Surgery, Klinikum Karlsruhe, Academic Teaching Hospital University of Freiburg, Karlsruhe, Germany (M.S.).
authors.forename: Thorben
authors.initials: T
authors.lastname: Breitkreuz
authors.affiliation: From the Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany (P.T., A.K., M.K., C.K., S.S., A.Z., H.-H.E.); AQUA - Institute for Applied Quality Improvement and Research in Health GmbH, Göttingen, Germany (T.K., T.B.); and Department for Vascular and Thoracic Surgery, Klinikum Karlsruhe, Academic Teaching Hospital University of Freiburg, Karlsruhe, Germany (M.S.).
authors.forename: Michael
authors.initials: M
authors.lastname: Kallmayer
authors.affiliation: From the Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany (P.T., A.K., M.K., C.K., S.S., A.Z., H.-H.E.); AQUA - Institute for Applied Quality Improvement and Research in Health GmbH, Göttingen, Germany (T.K., T.B.); and Department for Vascular and Thoracic Surgery, Klinikum Karlsruhe, Academic Teaching Hospital University of Freiburg, Karlsruhe, Germany (M.S.).
authors.forename: Christoph
authors.initials: C
authors.lastname: Knappich
authors.affiliation: From the Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany (P.T., A.K., M.K., C.K., S.S., A.Z., H.-H.E.); AQUA - Institute for Applied Quality Improvement and Research in Health GmbH, Göttingen, Germany (T.K., T.B.); and Department for Vascular and Thoracic Surgery, Klinikum Karlsruhe, Academic Teaching Hospital University of Freiburg, Karlsruhe, Germany (M.S.).
authors.forename: Sofie
authors.initials: S
authors.lastname: Schmid
authors.affiliation: From the Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany (P.T., A.K., M.K., C.K., S.S., A.Z., H.-H.E.); AQUA - Institute for Applied Quality Improvement and Research in Health GmbH, Göttingen, Germany (T.K., T.B.); and Department for Vascular and Thoracic Surgery, Klinikum Karlsruhe, Academic Teaching Hospital University of Freiburg, Karlsruhe, Germany (M.S.).
authors.forename: Martin
authors.initials: M
authors.lastname: Storck
authors.affiliation: From the Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany (P.T., A.K., M.K., C.K., S.S., A.Z., H.-H.E.); AQUA - Institute for Applied Quality Improvement and Research in Health GmbH, Göttingen, Germany (T.K., T.B.); and Department for Vascular and Thoracic Surgery, Klinikum Karlsruhe, Academic Teaching Hospital University of Freiburg, Karlsruhe, Germany (M.S.).
authors.forename: Alexander
authors.initials: A
authors.lastname: Zimmermann
authors.affiliation: From the Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany (P.T., A.K., M.K., C.K., S.S., A.Z., H.-H.E.); AQUA - Institute for Applied Quality Improvement and Research in Health GmbH, Göttingen, Germany (T.K., T.B.); and Department for Vascular and Thoracic Surgery, Klinikum Karlsruhe, Academic Teaching Hospital University of Freiburg, Karlsruhe, Germany (M.S.). Hans-Henning.Eckstein@mri.tum.de.
authors.forename: Hans-Henning
authors.initials: HH
authors.lastname: Eckstein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000453:epidemiology / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012306:Risk; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D013997:Time Factors
keywords: amaurosis fugax; carotid stenosis; cohort studies; ischemic attack, transient; systolic time interval