Timing of carotid endarterectomy after recent minor to moderate stroke
Hans SS, Acho RJ, and Catanescu I. Timing of carotid endarterectomy after recent minor to moderate stroke. Surgery 2018;164(4):820-824.
OBJECTIVE: Early carotid endartectomy is generally favored by vascular surgeons in patients after a minor to moderate stroke. Herein, we compared the results of early versus delayed carotid endartectomy in patients presenting with similar National Institutes of Health Stroke Scale findings after a recent minor to moderate stroke.
METHODS: A retrospective analysis of 101 patients undergoing carotid endartectomy after a recent stroke in the distribution of the branches of the middle cerebral artery with >70% internal carotid artery stenosis from 2000 to February 2018 was performed.
RESULTS: Sixty patients had carotid endartectomy within 2 weeks (group A) and 41 had carotid endartectomy within 2-8 weeks of stroke (group B). Associated factors, such as coronary artery disease, hypertension, diabetes mellitus, hyperlipidemia, nicotine abuse, chronic obstructive pulmonary disease, and renal failure, were similar in both groups. However, there was preponderance of male patients in group B (0.01). In group A, 35 patients presented with minor stroke (National Institutes of Health Stroke Scale 1-4) and 25 had a moderate stroke (National Institutes of Health Stroke Scale 5-15). In group B, 21 had a minor stroke and 20 had a moderate stroke (P = .54). Perioperative stroke occurred in 4 patients in group A and none in group B (P = .14), with perioperative stroke and death rate of 4.0%. Postoperative seizures occurred in 1 patient in group A and three in group B (P = .30).
CONCLUSION: Early as well as delayed carotid endartectomy in patients with minor to moderate stroke results in a satisfactory outcome. To prevent recurrent stroke in the waiting period, early carotid endartectomy should be preferred.
Medical Subject Headings
Aged; Aged, 80 and over; Carotid Stenosis; Endarterectomy, Carotid; Female; Humans; Male; Middle Aged; Retrospective Studies; Risk Factors; Stroke; Time Factors