Early carotid endarterectomy in patients with a nondisabling ischemic stroke: results of a retrospective analysis

• Published in: VASA Vol. 33; no. 1; p. 30
• Main Authors: Wölfle, K D, Pfadenhauer, K, Bruijnen, H, Becker, T, Engelhardt, M, Wachenfeld-Wahl, C, Schulze-Hamma, E, Loeprecht, H, Wohlgemuth, W A
• Format: Journal Article
• Language: English
• Published: Switzerland 01-02-2004
• Subjects: Aged; Carotid Artery, Internal - pathology; Carotid Artery, Internal - surgery; Carotid Stenosis - diagnosis; Carotid Stenosis - mortality; Carotid Stenosis - surgery; Cerebral Infarction - diagnosis; Cerebral Infarction - mortality; Cerebral Infarction - surgery; Disability Evaluation; Dominance, Cerebral - physiology; Endarterectomy, Carotid; Female; Germany; Hospital Mortality; Humans; Male; Middle Aged; Neurologic Examination; Outcome and Process Assessment (Health Care) - statistics & numerical data; Postoperative Complications - mortality; Recurrence; Survival Analysis; Time Factors; Tomography, X-Ray Computed; Germany
• ISSN: 0301-1526
• DOI: 10.1024/0301-1526.33.1.30

There are several recent recommendations not to delay carotid endarterectomy (CEA) for at least 4 weeks in patients experiencing a nondisabling ischemic stroke. Therefore, we re-examined if these patients could be safely operated on earlier: The aim of our study was to review the perioperative stroke and death rates of CEA performed within 30 days of stroke onset.
During a 4 year period until December 2001, in 66 neurologically stable patients suffering a nondisabling stroke ipsilateral to a carotid artery stenosis > 50% CEA was performed after a median interval of 10 (1-28) days. The modified Rankin scale (mRS) was applied to characterize the severity of impairment of daily living activities pre- and postoperatively: Any postoperative deterioration > 24 hours on the mRS was considered as a new stroke.
Operative mortality was 0%, and postoperative neurologic worsening > 24 hours occurred in 8/66 patients (12.1%). In 5/8 patients neurologic deterioration resolved within 5 days after surgery, only one stroke was permanent (1.5%). There was no correlation between timing of surgery or the presence of acute ipsilateral cranial CT defects with the occurrence of postoperative stroke. Stroke severity grading on admission according to the mRS, however, emerged to be a significant determinant of postoperative outcome: While 6/23 patients (26%) with an initial deficit > or = 3 on the mRS developed neurologic worsening, this was the case in only 2/43 patients (4.6%) with a deficit < or = 2 (Odds Ratio 7.2; 95% CI 1.32-39.49; two-sided p = 0.01).
Our results suggest that selected patients with a minor stroke (mRS < or = 2 on admission) can safely undergo early CEA.