Cor Vasa 2018, 60(2):e169-e173 | DOI: 10.1016/j.crvasa.2017.05.005

Carotid endarterectomy during the acute period of ischemic stroke

Peter Berek^a, Ivan Kopolovets^a,*, Vladimír Sihotský^a, Mária Kubíková^a, Peter Štefanič^a, Štefan Tóth^b, Csaba Dzsinich^c, Mária Frankovičová^a

^a Klinika cievnej chirurgie, Východoslovenský ústav srdcových a cievnych chorôb, a.s., a Lekárska fakulta Univerzity Pavla Jozefa Šafárika v Košiciach, Košice, Slovenská republika

^b I. interná klinika, Lekárska fakulta Univerzity Pavla Jozefa Šafárika v Košiciach a Univerzitná nemocnica L. Pasteura, Košice, Slovenská republika

^c Oddělení kardiovaskulární a hrudní chirurgie, Ústřední vojenská nemocnice, Budapešť, Maďarsko

Objective/background: High risk of recurrent ischemic stroke within the first 14 days after index event in patients with atherosclerotic stenosis of the carotid arteries gave the impetus for the revision of the term of performing carotid endarterectomy (CEA) in symptomatic patients. Nowadays the advisability of performing urgent CEA within 72 h after stroke onset in neurologically unstable patients is discussed frequently. The paper presents the evaluation of carotid endarterectomy during the acute period of ischemic stroke.

Methods: The results of CEA in 462 patients with symptomatic ICA stenosis performed in two independent Vascular Centers were analyzed. Indication for CEA was stenosis of ICA 50%. In Group I 28.5% of patients underwent CEA within 14 days after stroke onset, and in 71.5% of patients was performed 6 weeks after stroke onset. In Group II 39.5% of patients with unstable neurological symptoms underwent within 3-6 h after stroke onset, and in 60.5% of patients with unstable atherosclerotic plaque, CEA was performed within 24-48 h after stroke onset.

Results: In Group I (239 people) 7 (2.9%) patients developed stroke. Three (1.3%) patients died. In Group II (223 people) 5 (2.2%) patients developed stroke. One (0.4%) patient died. When comparing complications in the early postoperative period no statistical significance was found.

Conclusions: Urgent CEA is indicated in patients with unstable neurological symptoms as well as for those with unstable atherosclerotic plaques. Considering a high risk of stroke recurrence within the first 14 days urgent CEA is effective in the prevention of recurrent stroke. Only 2.2% patients developed postoperatively stroke.

Keywords: Atherosclerosis; Carotid endarterectomy; Stenosis of carotid arteries; Stroke; Transient ischemic attack

Received: December 28, 2016; Accepted: May 14, 2017; Published: April 1, 2018  Show citation