Early reintervention improves outcomes in patients with stroke after carotid endarterectomy: observational study.

Intraoperative carotid artery duplex scanning in a modern series of 650 consecutive primary endarterectomy procedures

Comparative analysis of stroke-related disability and mortality after carotid endarterectomy and carotid artery stenting using the modified Rankin Scale.

Improvement of Cognitive Function after Carotid Endarterectomy—A New Strategy for the Evaluation of Cognitive Function

Very Early CEA Without Shunting for Stroke—The Preferred Therapy

Association between index symptom and timing on perioperative stroke rate in patients undergoing carotid endarterectomy.

Most patients experiencing 30-day postoperative stroke after carotid endarterectomy will initially experience disability

Reporting Standards for Carotid Artery Angioplasty and Stent Placement

Early Carotid Surgery in Patients After Acute Ischemic Stroke: Is it Safe? A Retrospective Analysis in a Single Center Between Early and Delayed/Deferred Carotid Surgery on 285 Patients

Invited commentary

To evaluate the efficacy and safety of supra-aortic vessels reconstruction within acute period of stroke. Early surgery was performed in 7 patients aged 67±9 years. Revascularization was made after 4.6 days after ischemic stroke on the average (range from 2 to 7 days). Neurological status before and after surgery was assessed using NIHSS scale, mean preoperative score was 3.9±2.7 (0-7). All patients had ischemic brain lesions (4-32 mm, mean 10 mm) unilateral with carotid stenosis or occlusion. Carotid artery stenting was performed in 2 patients, carotid endarterectomy - in 4 patients and stenting of segment I of the left subclavian artery was made in 1 case. There were no mortality and recurrent postoperative ischemic stroke. Complications occurred in two patients: postoperative hematoma and intraoperative transient ischemic attack that developed during CAS after 5 days of a stroke. There was positive neurological dynamics after revascularization: there was almost 2-fold decrease of mean score of neurological deficit (from 3.9±2.7±1.7 to 2). Early surgical prevention of recurrent stroke (up to 7 days) can be performed effectively and safely in carefully selected patients with ischemic stroke (neurological deficit less than 3 Rankin scores and less than 7 NIHSS scores, ischemic lesion dimensions lass than 4 cm). Reconstruction of supra-aortic vessels in acute stage of stroke improves the neurological status and reduces the degree of motor and sensory disorders. However, currently there are no clear criteria for inclusion and exclusion of patients for early revascularization using both degree of neurological deficit and size of ischemic lesion. So our results need to be confirmed by large trials.

To assess an efficacy and safety of brachiocephalic arteries reconstruction at the acute stage of stroke. Early reconstruction of brachiocephalic arteries was made in 7 patients (mean age 67±9 years). Mean terms of brachiocephalic arteries reconstruction after stroke were 4.6 days (range 2-7 days). Pre- and postoperative neurological state was assessed by NIHSS score (mean preoperative score was 3.9±2.7 in these 7 patients, range 0-7). All patients had ipsilateral cerebral ischemic lesions with stenosis/occlusion of brachiocephalic artery. Their mean dimension was 10 mm (range 4-32 mm). Internal carotid artery stenting was made in 2 patients, carotid endarterectomy - in 4 patients, stenting of the 1st segment of left subclavian artery - in 1 patient. There were no deaths and recurrent postoperative ischemic strokes. Complications developed in 2 patients: postoperative hematoma and intraoperative transient ischemic attack during ICA stenting in 5 days after stroke. There was a positive course of neurological state after brachiocephalic arteries reconstruction: mean score of neurological deficit decreased by almost 2 times (from 3.9±2.7 to 2±1.7). Early surgical prevention (within 7 days after stroke) may be effective and safe in certain patients with ischemic stroke (neurological deficit by Rankin score ≤3 and NIHSS ≤7, ischemic focus dimension less than 4 cm). Brachiocephalic arteries reconstruction early after stroke improves neurological state postoperatively by reducing motor and sensitive disorders. However, at present time there are no clear indications for early revascularization depending on either neurological deficit severity and ischemic focus dimension. So, our data should be confirmed by large trials.

Higher stroke risk after carotid endarterectomy and transcarotid artery revascularization is associated with relative surgeon volume ratio

Carotid endarterectomy under local and/or regional anesthesia has less risk of myocardial infarction compared to general anesthesia: An analysis of national surgical quality improvement program database.

Part One: For the Motion. Completion Angiography Should be Used Routinely Following Carotid Endarterectomy

Frailty as measured by the Risk Analysis Index is associated with long-term death after carotid endarterectomy