Abstract
Aim: Carotid endarterectomy (CEA) is the choice of treatment for prevention of cerebrovascular events in vulnerable patients. In this single-center multi surgeon study, we aimed to evaluate outcomes of neurologically stable patients who underwent CEA after symptoms of cerebrovascular event according to time between the event and operation. Methods: In our clinic during 2008-2012, we applied 67 CEA to 65 patients. Ten of these 65 patients excluded from trial due to combined CABG operation. 18 patients were asymptomatic prior to operation and excluded. Thirty-nine of these patients were symptomatic and enrolled to study. Data were collected retrospectively. All enrolled patients were divided into two groups, according to the time between event and operation. Group I: Early Group (≤14 days). Group II: Late Group (>14 days). Results: In our clinic during 2008-2012, we applied 39 CEA procedures to consecutive 37 patients with symptomatic carotid artery stenosis. None of preoperative variables were associated with postoperative mortality (p > 0.05). We observed postoperative bleeding in one patient who was in Late Group (II). Postoperative bleeding was only associated with hyperlipidemia (p = 0.003). Postoperative stroke was observed in moderate cardiac risk patients in Early Group (I) (p = 0.003). But none of the postoperative complications were associated with study groups. We observed that, closure technique (primary closure) was associated with postoperative stroke (p = 0.030). We have achieved shorter waiting time during study time phrase but it couldn’t reached statistical significance (p = 0.196). Conclusion: Although symptomatic patients have a higher risk of perioperative complications compared with asymptomatic patients, early CEA after symptom onset does not influence the results. This raises the question of the optimal timing of Carotid Artery intervention in symptomatic carotid artery stenosis. To answer this question, more data are needed preferably from large randomized trials.
Highlights
Carotid endarterectomy (CEA) is the choice of treatment for prevention of cerebrovascular events in vulnerable patients
In this present single-center multi surgeon study, we aimed to evaluate outcomes of neurologically stable patients who underwent CEA after symptoms of cerebrovascular event according to time between event and operation
Postoperative stroke was observed in moderate cardiac risk patients both were in Early Group (I) (p = 0.003) but none of the postoperative complications were associated with study groups (Table 3)
Summary
Carotid endarterectomy (CEA) is the choice of treatment for prevention of cerebrovascular events in vulnerable patients. European guidelines recommend revascularization within 2 weeks of index event (first symptom described by the patient) in patient with symptomatic carotid artery stenosis [1]-[5]. In several vascular centers including our clinic, shorter waiting times have been achieved over the last few years, but the majority of patients are still not treated within the recommended 2 weeks from symptoms [6]-[8]. Rantner et al demonstrated no difference in major complication rates among 29 CEAs performed before and 62 CEAs performed after 28 days from symptoms. Faggioli et al reported no statistical difference of perioperative stroke rate according to operation time
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