Timing of Carotid Intervention in Symptomatic Cerebrovascular Disease: Outcomes of a Single-Institution Experience

Abstract

The optimal timing for carotid endarterectomy in patients with symptomatic cerebrovascular disease has remained unclear. We compared the clinical outcomes of carotid endarterectomy performed before and 2 weeks after symptom onset. A retrospective analysis was performed of patients who had presented to our institution with symptomatic cerebrovascular disease, defined by the presence of transient ischemic attack (TIA) or cardiovascular accident (CVA) symptoms, from January 2012 to February 2020. The data collected included demographics, National Institutes of Health stroke scale (NIHSS) and modified Rankin scale (mRS) scores, and postoperative complications, including recurrent TIA or CVA, myocardial infarction, and death during admission and at discharge. The patients were followed up for 1 year. The primary end points included NIHSS scores, mRS scores, and changes in the scores from baseline to 30 days, with the secondary end points extending to 90 days and 1 year. A total of 169 patients were included, of whom, 58.6% had undergone carotid endarterectomy within 2 weeks of symptom onset. The baseline demographic and clinical characteristics were similar between groups. No differences in the primary or secondary end points were demonstrated at any interval (P = 1.0, P = .77, and P = .4 for the 30-day NIHSS score, mRS score, and 30-day change in the mRS score, respectively; and P = .9, P = .22, and P = .07 for the 90-day NIHSS score, mRS score, and 1-year mRS score, respectively). We found a difference in postoperative complications, including recurrent TIA/CVA, myocardial infarction, and death. A subgroup analysis of interventional neurology involvement was performed; they had evaluated 44.4% of the patients. No further intervention was required for 42.7%, diagnostic cerebral arteriography was performed in 36.0%, and an additional intervention was required for 21.3%. Interventional neurology involvement demonstrated no differences in the primary or secondary end points. Carotid endarterectomy was safe if performed within 2 weeks of symptom onset with equivalent outcomes compared with delayed surgery. Involvement of interventional neurology did not affect the neurologic outcomes for early vs late operative timing.