Carotid Endarterectomy Timing After Stroke

Study Questions:

What is the optimal time to perform carotid endarterectomy (CEA) in patients with symptomatic carotid stenosis?

Methods:

The authors analyzed the outcome of 56,336 elective CEA procedures performed for symptomatic carotid stenosis in Germany between 2009 and 2014. The patient cohort was divided into four groups according to the number of days between index event and surgery (I: 0-2, II: 3-7, III: 8-14, and IV: 14-180 days). Primary outcome was a composite of in-hospital stroke or death.

Results:

The median delay to surgery was 9 days. The majority of patients (67%) were men and the mean age was 71 years. The overall rate of any stroke or death was 2.5% (n = 1,434). There was no difference in the risk of in-hospital stroke or death across the four groups (3.0% in group I, 2.5% in group II, 2.6% in group III, and 2.3% in group IV).

Conclusions:

The time interval between the index event and CEA was not associated with the risk of any in-hospital stroke or death in patients with symptomatic carotid stenosis.

Perspective:

The current guidelines recommend surgical revascularization within 2 weeks in patients with symptomatic carotid stenosis. This is based on the observation that the risk of subsequent stroke (without revascularization) is highest immediately following the index event. This study suggests that early surgery (as recommended by the guidelines) is safe and should remain the default clinical strategy.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Vascular Medicine, Interventions and Vascular Medicine

Keywords: Cardiac Surgical Procedures, Carotid Stenosis, Endarterectomy, Carotid, Myocardial Revascularization, Risk, Stroke, Vascular Diseases


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