Risk of early carotid endarterectomy for symptomatic carotid stenosis

Waleed Brinjikji, Alejandro A. Rabinstein, Fredric B. Meyer, David G. Piepgras, Giuseppe Lanzino

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Background And Purpose-: The purpose of this study was to determine and compare the rate of stroke, myocardial infarction, and death in patients undergoing early and late carotid endarterectomy (CEA) after a symptomatic event and in asymptomatic patients. Methods-: We conducted a retrospective analysis of all CEAs performed in the Department of Neurosurgery between January 2004 and May 2009. Patients were divided into 3 groups: Group 1, asymptomatic patients; Group 2, symptomatic patients operated on >2 weeks after their transient ischemic attack or stroke; and Group 3, symptomatic patients operated on ≤2 weeks of their transient ischemic attack or stroke. Primary outcomes were any myocardial infarction, stroke, or death occurring within 30 days postoperatively. The secondary end point was transient ischemic attack within 30 days postoperatively. Results-: Five hundred thirty-two CEAs were performed on 507 patients during the study period. Thirty-day follow-up was available for 500 patients with 525 CEAs. Groups 1, 2, and 3 consisted of 278, 105, and 142 CEAs, respectively. In total, 12 patients had primary outcomes. In Group 1, 5 patients had primary outcomes of stroke, myocardial infarction, or death (1.8%); in Group 2, 1 patient had primary outcomes (1.0%); and in Group 3, 6 patients had primary outcomes (4.2%). There was no significant difference in the rate of primary outcomes among the 3 groups (P=0.17) or when Groups 2 and 3 were compared (P=0.24). Conclusions-: Although the perioperative risk of transient ischemic attacks, stroke, death, and myocardial infarction is slightly higher in symptomatic patients operated on early, CEA can be done with an acceptable risk in properly selected symptomatic patients within 2 weeks of their transient ischemic attack or stroke.

Original languageEnglish (US)
Pages (from-to)2186-2190
Number of pages5
JournalStroke
Volume41
Issue number10
DOIs
StatePublished - Oct 1 2010

Keywords

  • TIA
  • carotid endarterectomy
  • carotid stenosis
  • stroke care
  • symptomatic carotid stenosis

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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