Safety of urgent endarterectomy in acute non-disabling stroke patients with symptomatic carotid artery stenosis: an international multicenter study.

Abstract

International recommendations advocate that carotid endarterectomy (CEA) should be performed within 2weeks from the index event in symptomatic carotid artery stenosis (sCAS) patients. However, there are controversial data regarding the safety of CEA performed during the first 2days of ictus. The aim of this international, multicenter study was to prospectively evaluate the safety of urgent (0-2days) in comparison to early (3-14days) CEA in patients with sCAS. Consecutive patients with non-disabling (modified Rankin Scale scores ≤2) acute ischaemic stroke or transient ischaemic attack due to sCAS (≥70%) underwent urgent or early CEA at five tertiary-care stroke centers during a 6-year period. The primary outcome events included stroke, myocardial infarction or death during the 30-day follow-up period. A total of 311 patients with sCAS underwent urgent (n=63) or early (n=248) CEA. The two groups did not differ in baseline characteristics with the exception of crescendo transient ischaemic attacks (21% in urgent vs. 7% in early CEA; P=0.001). The 30-day rates of stroke did not differ (P=0.333) between patients with urgent (7.9%; 95% confidence interval 3.1%-17.7%) and early (4.4%; 95% confidence interval 2.4%-7.9%) CEA. The mortality and myocardial infarction rates were similar between the two groups. The median length of hospitalization was shorter in urgent CEA [6days (interquartile range 4-6) vs. 10days (interquartile range 7-14); P<0.001]. Our findings highlight that urgent CEA performed within 2days from the index event is related to a non-significant increase in the risk of peri-procedural stroke. The safety of urgent CEA requires further evaluation in larger datasets.