Sharma V, and Hans S. Carotid Endarterectomy During Index Hospital Admission for Patients With Acute Mild to Moderate Stroke. J Vasc Surg 2021; 74(3):E144-E145.
J Vasc Surg
Objective: The timing of carotid endarterectomy (CEA) after acute stroke due to an infarct in themiddle cerebral artery territory with ipsilateral internal carotid artery stenosis remains controversial. We evaluated the results of CEA in this group of patients during the index hospital admission.
Methods: We performed a retrospective review of all patients admitted with acute, mild (National Institutes of Health [NIH] stroke scale score, 1-5) and moderate stroke (NIH stroke scale score, 6-14) in the distribution of the middle cerebral artery with $70% ipsilateral internal carotid artery stenosis admitted to two midsize teaching hospitals with stroke certification from 2005 to 2020. Patients with focal transient ischemic attacks were excluded. An indwelling shunt was placed if the patient developed a new neurologic deficit with carotid cross-clamping or ischemic electroencephalographic changes under general anesthesia.
Results: A total of 74 patients (45 men) aged 35 to 87 years (mean age, 70.1 6 10.8 years). Of the 74 patients, 61 had a NIH stroke scale score of 1 to 5) and 13 an NIH stroke scale score of 6 to 14. Twelve patients were given intravenous tissue plasminogen activator. Of the 74 patients, 21 had undergone CEA 3 to 5 days after stroke and 53 had done so 6 to 8 days after stroke. Cervical block anesthesia was used for 54 patients (20 with general anesthesia), and a shunt was required for 15 patients (20%). Four patients (5.4%) had experienced severe postoperative stroke (three new ischemic infarcts and one intracerebral hemorrhage), resulting in death in all four. Two patients (2.7%) had developed postoperative seizures. Two patients (2.7%) had experienced temporary cranial nerve palsy (hypoglossal in one, ramus mandibularis in one).
Conclusions: CEA for acute mild to moderate stroke can be performed with satisfactory results during the index admission. This strategy is useful to prevent recurrent stroke.