Abstract 57: Safety of Early and Urgent Carotid Endarterectomy (CEA) in Symptomatic Carotid Artery Stenosis (sCAS): An International, Multicenter Study
Background&Purpose: Although the latest AHA recommendations suggest that CEA should be performed within two weeks of the index event in patients with sCAS, only a minority of patients undergoes surgery within the recommended time-frame because of a perceived higher incidence of complications. The aim of this international, multicenter study was to prospectively evaluate the safety of early CEA in patients with SCAS in “everyday clinical practice” settings.
Subjects&Methods: Consecutive patients with non-disabling (modified Rankin Scale grade<3) acute ischemic stroke (AIS) or TIA due to sCAS (≥70%) underwent early (≤14 days from symptom onset) CEA at five tertiary care stroke centers during a two-year period. Primary outcome events included any stroke, myocardial infarction (MI) or death occurring during the 30-day follow-up period and were defined according to the International Carotid Stenting Study criteria. Secondary outcome events included cranial nerve palsy (CNP) and neck hematoma (NH).
Results: A total of 165 patients with sCAS (mean age 69±10years; 69% men; 70% acute ischemic stroke, 30% TIA; crescendo TIA 6%; contralateral internal carotid artery occlusion 8%) underwent early CEA during the study period. The median elapsed time from symptom onset to carotid revascularization was 8 days (range 1-14). A total of 20 (12%) patients underwent urgent CEA (within two days from symptom onset). The primary outcomes of stroke and MI were 4.8% (95%CI: 1.5%-8.1%) and 0.6% (0%-1.8%) respectively. All strokes included cerebral infarctions that occurred in the territory of the symptomatic internal carotid artery (ICA). The combined outcome event of non-fatal stroke, non-fatal MI or death was 5.5% (2.0%-9.0%). The rates of CNP and NH were 6.7% and 3.6%. Crescendo TIA, contralateral ICA occlusion and urgent CEA were not associated (p>0.2) with a higher rate of peri-procedural events.
Conclusions: Our findings indicate that the risk of early CEA in consecutive unselected patients with non-disabling stroke or TIA due to sCAS is acceptable when the procedure is performed within 2 weeks as well as within 2 days from symptom onset.
Author Disclosures: G. Tsivgoulis: None. C. Krogias: None. G.S. Georgiadis: None. R. Mikulik: None. D. Athanasiadis: None. A. Safouris: None. S.H. Meves: None. K. Vadikolias: None. K. Voumvourakis: None. M. Haršány: None. I. Heliopoulos: None. S. Papageorgiou: None. E. Georgakarakos: None. E. Tampaki: None. A. Lazaris: None. C. Piperidou: None. E. Stamboulis: None. L. Stefanis: None. M. Lazarides: None. S.N. Vasdekis: None.
- © 2014 by American Heart Association, Inc.