Early versus Delayed Carotid Endarterectomy for Symptomatic Carotid Stenosis: A Single-Institution Experience
Suman Annambhotla, Michael S. Park, Mark L. Keldahl, Mark D. Morasch, Heron E. Rodriguez, William H. Pearce, Melina R. Kibbe, Mark K. Eskandari
Northwestern University, Chicago, IL
INTRODUCTION: Delayed carotid endarterectomy (CEA) after a recent stroke or transient ischemic attack (TIA) is associated with risks of recurrent neurologic symptoms. In an effort to preserve cerebral function, urgent early CEA has been recommended in some instances.
METHODS: Retrospective chart review from a single university hospital tertiary care center between November 1998 and February 2011 revealed 309 patients who underwent CEA following stroke or TIA. Of these 309 patients, 87 received their CEA within 30 days of symptom onset and 222 received their CEA after 30 days from symptom onset. The early CEA cohort was further stratified according to the timing of surgery: Group A (33 patients), within 7 days; Group B (21), between 8 and 14 days; Group C (17), between 15 and 21 days; and Group D (15), between 22 and 30 days. Demographic data as well as 30-day (mortality, stroke, TIA, and myocardial infarction) and long-term (all-cause mortality and stroke) rates were analyzed for each Group. These were also analyzed for the entire early CEA cohort and compared against the delayed CEA cohort.
RESULTS: Demographics and co-morbid conditions were similar between groups. For 30-day outcomes, there were no deaths (0%), two strokes (2.4%), two TIAs (2.4%), and two myocardial infarctions (2.4%) in the early CEA cohort; in the delayed CEA cohort, there were 4 (1.8%), 4 (1.8%), 3 (1.4%), and 3 (1.4%) patients with these outcomes, respectively (p > 0.05 for all comparisons). Over the long-term, the early group had one ipsilateral stroke at 17 months and the delayed group had two ipsilateral strokes at 3 and 12 months. For long-term outcomes, there were 21 deaths in the early CEA cohort (24.4%) and 67 deaths in the delayed CEA cohort (30.2%, p > 0.05). Mean follow-up times were 4.5 years in the early CEA cohort and 5.8 years in the delayed CEA cohort.
CONCLUSIONS: There were no differences in 30-day and long-term adverse outcome rates between the early and delayed CEA cohorts. Early CEA is preferred in carefully selected patients following a TIA or non-disabling stroke over delayed CEA.
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