IP121. Early Carotid Endarterectomy in Symptomatic Patients∗

Abstract

The objective of this study was to evaluate whether early carotid endarterectomy (CEA) in symptomatic patients is associated with higher rates of stroke or death in the postoperative period. A retrospective study from 2016 to 2017 was conducted in our institution. In the indexed period, 68 patients matched the inclusion criteria. Patients’ characteristics and results were recorded in a dedicated database. All patients were submitted to a preoperative and postoperative clinical examination by an independent neurologist and were divided into four groups based on the surgical timing (0-7 days; 7-15 days; 15-30 days; >30 days). National Institutes of Health Stroke Scale score was also calculated in all cases. In all patients, the level of serologic and intraplaque ST2 (suppression of tumorigenicity) was evaluated as a potential marker of plaque instability. Data were analyzed with χ2 test and Kaplan-Meier curves (SPSS 24.0 statistical software; IBM Corp, Armonk, NY). Of 68 patients treated, 47 were male (69%), with a median age of 70 years (range, 48-83 years); 82% suffered from hypertension, and 29% were diabetic patients. Preoperative symptoms consisted of transient ischemic attack (43%), minor stroke (32%), major stroke (23%), and crescendo transient ischemic attack (2%). Degree of stenosis was between 60% and 80% in 63% of the patients, between 80% and 99% in 27%, and near occlusion in 10%. CEA was performed in 100% of cases with a National Institutes of Health Stroke Scale score between 0 and 8: 8 (12%) eversion CEAs and 60 (88%) CEAs with patch. Eleven patients (16%) were treated within 7 days; 24 (35%) were assigned to the second group (7-15 days), 12 (18%) to the third group (15-30 days), and 21 (31%) to fourth group. No neurologic events or deaths were recorded at 30 days. There was no statistical difference between the four groups regarding ST2 marker levels. In the median follow-up of 12 months (range, 1-24 months), stroke-free survival rate was 100%. The time between neurologic event and CEA did not influence the early and midterm results in our series. Early CEA may be safely proposed also in patients with major stroke.