Abstract
Background. Although many retrospective and a few prospective studies have analyzed the outcome
of early and delayed carotid endarterectomy (CEA) after a recent minor or nondisabling
stroke (ie, a minimal and stabilized focal neurologic deficit of acute onset persisting
for more than 24 hours and not leading to a handicap or to a significant impairment
of daily living activities), the optimal timing of surgery remains uncertain. The
purpose of this study was to prospectively compare the perioperative death and stroke
rates of CEA performed within 30 days (early group) or more than 30 days (delayed
group) after a nondisabling ischemic stroke in patients with carotid bifurcation disease.
Methods. During a 4-year period, of 86 patients experiencing a minor stroke, 45 were randomized
to undergo early CEA and 41 to undergo delayed CEA. All patients underwent preoperative
cerebral computed tomography, duplex ultrasonographic scanning and angiography of
the supra-aortic trunks. All CEAs were carotid eversion endarterectomies and were
performed by the same surgeon, using deep general anesthesia, with continuous electroencephalographic
monitoring for the selective shunting. The perioperative death and stroke rates were
compared between the 2 groups. Results. No perioperative deaths occurred in either group. No recurrent strokes occurred during
the waiting period in the delayed group. The incidence of perioperative stroke was
comparable in the 2 groups (1 of 45, 2% vs 1 of 41, 2%). The mean follow-up was 23
months (range, 6 to 50 months). Survival rates after 1, 2, and 3 years were similar
in the 2 groups. Conclusions. Early CEA after a nondisabling ischemic stroke can be performed safely with perioperative
mortality and stroke rates comparable with those of delayed CEA. The timing of surgery
does not seem to influence the benefit of the CEA. (Surgery 2002;131:287-93.)
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Article info
Publication history
Accepted:
September 3,
2001
Footnotes
*Reprint requests: Enzo Ballotta, MD, Section of Vascular Surgery, Department of Medical and Surgical Sciences, University of Padua, School of Medicine, Policlinico Universitario, Via N. Giustiniani, 2, 35128 Padova, Italy.
Identification
Copyright
© 2002 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
