Efficacy and safety of carotid endarterectomy in the acute phase of ischemic stroke

Abstract

Introduction.Nowadays it’s recommended to perform carotid endarterectomy (CEA) in up to 14 days after nondisabling stroke; the procedure is aimed at the prevention of recurrent stroke.The objectiveof this research was the comparison of short-term and long-term (12 months) outcomes with early (in up to 30 days) and delayed (30-180 days) CEA in patients who suffered strokes of various severities.Materials and methods. The research involved 88 patients who underwent CEA in the early stage (Group 1) and 88 patients who underwent CEA in their late period (Group 2). We assessed primary endpoints: ipsilateral stroke, myocardial infarction, 30-day Lethality, 30-day lethality after the surgery, any stroke or infarction (MACE). Secondary endpoints: the same parameters within 12 months after the surgery, post-surgery local or systemic complications, restenosis, changes in neurologic or cognitive status.Results.In 30 days we observed ipsilateral strokes in 3 patients in Group 1 (3.4 percent), it was lethal in 1 patient (1.1 percent). 170 of 176 (96 percent) patients were followed up for 12 months. One lethal stroke was registered in the group of late interventions (1.1 percent). No statistically significant differences were observed between the outcomes in early and late treatment groups. The severity of disability (mRS) in patients of the early intervention group was significantly smaller at discharge and in 12 months after surgery.Conclusion.The advisability of early CEA performance was proven by the absence of differences in post-surgery 30-day and longterm lethality as well as the progress of stroke or infarction with early or late CEA. In 12 months after the surgeries, significant improvement in neurologic status by mRS was only observed in the group of early interventions.