The National Norwegian Carotid Study; Time From Symptom Debut To Surgery is Too Long, Giving Additional Neurological Events

Abstract

surgery. The incidence of these DWI lesions was compared between the shunting and the non-shunting group. A subgroup analysis was performed to differentiate between asymptomatic and symptomatic carotid stenosis. Results: Shunt use was similar in both asymptomatic and symptomatic carotid stenosis group (21.8% vs. 26.2%, respectively; p 1⁄4 0.38). The overall incidence of emboligenic DWI lesions is 8.7% (32/366). In the non-shunting group (n 1⁄4 280), a 7.1% incidence is reported, whereas in the shunting group (n 1⁄4 86), a 14.0% incidence is seen (borderline non-significant difference; p 1⁄4 0.08). In the asymptomatic carotid stenosis group, there were significantly more emboligenic DWI lesions when a shunt was used, compared to when no shunt was used (16.3% vs. 5.7% incidence, respectively; p 1⁄4 0.03). In the symptomatic carotid stenosis group, no difference in incidence of emboligenic DWI lesions was found when a shunt was used or not (10.8% vs. 9.6%; p 1⁄4 0.76). Only one patient with an emboligenic DWI lesion presented with a stroke; all other lesions were clinically silent (31/32; 97%). Conclusion: There is a tendency for higher incidence of emboligenic DWI lesions when using a shunt during CEA. Subgroup analysis for the asymptomatic carotid stenosis group shows a statistically significant higher incidence of emboligenic DWI lesions when a shunt was used, compared to when no shunt was used. Most of these emboligenic DWI lesions are clinically silent. The clinical relevance of cerebral embolization during CEA is still under debate. Therefore, the use of a shunt during CEA must be carefully considered especially in asymptomatic patients. Disclosure of Interest: None Declared.