Analysis of early Versus Delayed Carotid Surgery after Acute Ischemic Stroke

Abstract

Objective: Evaluate the 30-day outcomes of patients with an internal carotid artery (ICA) stenosis responsible for an acute brain infarct who underwent early (≤ 14 days) carotid endarterectomy (CEA) or delayed (15 days to 3 months) CEA. Methods: From July 2010 to June 2014, patients with a recent cerebral infarct who underwent CEA within 3 months after symptom onset were collected. This was a continuous, monocentric, and retrospective series. Two groups were identified : Group A with patients who underwent CEA in the first fourteen days after symptom onset and Group B with patients who underwent CEA from the fifteenth day to the third month after symptom onset. Death, stroke and major cardiac events were analyzed. Results: Seventy-one patients with ICA stenosis responsible for an acute brain infarct underwent CEA (73.2% men, with a median age of 71). Nineteen patients underwent early CEA and 52 underwent delayed CEA. The mean interval from initial examination to surgery was 9.5 days (range, 3-14 days) in Group A and was 42 days (range, 15-92 days) in Group B. After one month, and with a 98.6% follow-up, no postoperative complication occurred in Group A and 2 patients had post-operative stroke (3.8%) in Group B. Conclusion: This retrospective study confirms the satisfactory outcomes of early CEA after acute brain infarct. A strict clinical and radiological selection of patients allows to prevent early neurological complications. Keywords : carotid stenosis, early surgery, results, brain infarct.