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Safety of early endarterectomy in patients with symptomatic carotid artery stenosis: An international multicenter study

par Tsivgoulis, Georgios;Krogias, Christos;Georgiadis, George G.S.;Mikulik, Robert;Safouris, Apostolos ;Meves, Saskia Hannah;Voumvourakis, Konstantinos;Haršány, Michal;Staffa, Robert;Papageorgiou, Sokratis S.G.;Katsanos, Aristeidis A.H.;Lazaris, Andreas;Mumme, Achim;Lazarides, Miltos;Vasdekis, Spyros S.N.
Référence European journal of neurology, 21, 10, page (1251-1e76)
Publication Publié, 2014-10

Article révisé par les pairs

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Résumé :

Background and purpose: Although the latest recommendations suggest that carotid endarterectomy (CEA) should be performed in symptomatic carotid artery stenosis (sCAS) patients within 2 weeks of the index event, only a minority of patients undergo surgery within the recommended time-frame. 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. Methods: Consecutive patients with non-disabling acute ischaemic stroke (AIS) or transient ischaemic attack (TIA) due to sCAS (≥70%) underwent early (≤14 days) CEA at five tertiary-care stroke centers during a 2-year period. Primary outcome events included 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. Results: A total of 165 patients with sCAS [mean age 69 ± 10 years; 69% men; 70% AIS; 6% crescendo TIA; 8% with contralateral internal carotid artery (ICA) occlusion] underwent early CEA (median elapsed time from symptom onset 8 days). Urgent CEA (≤2 days) was performed in 20 cases (12%). The primary outcomes of stroke and MI were 4.8% [95% confidence interval (CI) 1.5%-8.1%] and 0.6% (95% CI 0%-1.8%). The combined outcome event of non-fatal stroke, non-fatal MI or death was 5.5% (95% CI 2.0%-9.0%). Crescendo TIA, contralateral ICA occlusion and urgent CEA were not associated (P > 0.2) with a higher 30-day stroke rate. Conclusions: Our findings indicate that the risk of early CEA in consecutive unselected patients with non-disabling AIS or TIA due to sCAS is acceptable when the procedure is performed within 2 weeks (or even within 2 days) from symptom onset. Click here for the corresponding questions to this CME article.