Safety of carotid endarterectomy in relation to the timing after ischemic stroke

Česká verzia

Authors: I. Guňka ¹; D. Krajíčková ²; M. Leško ¹; S. Jiška ¹; J. Raupach ³; V. Chovanec ³; Miroslav Lojík ³ ; A. Hudák ¹; O. Renc ³; R. Malý ⁴
Authors place of work: Chirurgická klinika LF UK a FN Hradec Králové ¹; Neurologická klinika LF UK a FN Hradec Králové ²; Radiologická klinika LF UK a FN Hradec Králové ³; I. interní kardioangiologická klinika LF UK a FN Hradec Králové ⁴
Published in the journal: Cesk Slov Neurol N 2020; 83/116(4): 394-399
Category: Original Paper
doi: https://doi.org/10.14735/amcsnn2020394

Summary

Aim: To assess the procedural risk of carotid endarterectomy (CEA) in relation to its timing after ischemic stroke and to define the reasons that delay surgery beyond the recommended time interval.

Materials and methods: A retrospective analysis was performed using prospectively collected data from all consecutive patients with symptomatic internal carotid artery stenosis who underwent CEA during the period from January 2013 to August 2019. The patients were divided into four groups according to the timing of CEA: group 1 – CEA within 2 days; group 2 – CEA between 3–7 days; group 3 – CEA between 8–14 days; and group 4 – CEA between 15–180 days. The primary outcome measure was the combined perioperative rate of any stroke or death within 30 days.

Results: A total of 246 patients were included in the study. The median time interval between stroke and CEA was 8 days. A total of 191 patients (77.6%) underwent CEA within the recommended 14-day period from ischemic stroke, whereas 55 patients (22.4%) underwent CEA more than 14 days after stroke. Medical reasons were the cause of CEA delay in only 18 out of these 55 patients. For the entire cohort, the overall 30-day rate of any stroke or death was 3.7% (9 patients out of 246). The procedural risk was 5.9% (3 patients out of 51) in group 1, 1.5% (1 patient of 68) in group 2, 5.6% (4 patients out of 72) in group 3, and 1.8% (1 patient out of 55) in group 4 (P = 0.477).

Conclusion: In this study, the time interval between the stroke and CEA was not associated with significant increase of procedural risk of any stroke or death.

Keywords:

carotid endarterectomy – stroke – emergent – periprocedural complications

Zdroje

1. Naylor AR, Ricco JB, de Borst GJ et al. Management of atherosclerotic carotid and vertebral artery disease: 2017 Clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2018; 55 (1): 3–81. doi: 10.1016/j.ejvs.2017.06.021.

2. Škoda O, Herzig R, Mikulík R et al. Klinický standard pro diagnostiku a léčbu pacientů s ischemickou cévní mozkovou příhodou a s tranzitorní ischemickou atakou – verze 2016. Cesk Slov Neurol N 2016; 112/79 (3): 351–363. doi: 10.14735/amcsnn2016351.

3. Rothwell PM, Eliasziw M, Gutnikov SA et al. Carotid endarterectomy trialists collaboration. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet 2004; 363 (9413): 915–924.

4. Strömberg S, Gelin J, Osterberg T et al. Very urgent carotid endarterectomy confers increased procedural risk. Stroke 2012; 43 (5): 1331–1335. doi: 10.1161/STROKEAHA. 111.639344.

5. Loftus IM, Paraskevas KI, Johal A et al. Delays to surgery and procedural risks following carotid endarterectomy in the UK national vascular registry. Eur J Vasc Endovasc Surg 2016; 52 (4): 438–443. doi: 10.1016/j.ejvs.2016. 05.031.

6. Tsantilas P, Kuehnl A, König T et al. Short time interval between neurologic event and carotid surgery is not associated with an increased procedural risk. Stroke 2016; 47 (11): 2783–2790. doi: 10.1161/STROKEAHA.116.014058.

7. Kjørstad KE, Baksaas ST, Bundgaard D et al. The National Norwegian Carotid Study: time from symptom onset to surgery is too long, resulting in additional neurological events. Eur J Vasc Endovasc Surg 2017; 54 (4): 415–422. doi: 10.1016/j.ejvs.2017.07.013.

8. Nordanstig A, Rosengren L, Strömberg S et al. Very urgent carotid endarterectomy is associated with an increased procedural risk: The Carotid Alarm Study. Eur J Vasc Endovasc Surg 2017; 54 (3): 278–286. doi: 10.1016/j.ejvs.2017.06.017.

9. Milgrom D, Hajibandeh S, Hajibandeh S et al. Systematic review and meta-analysis of very urgent carotid intervention for symptomatic carotid disease. Eur J Vasc Endovasc Surg 2018; 56 (5): 622–631. doi: 10.1016/j.ejvs.2018.07.015.

10. Tsantilas P, Kühnl A, Kallmayer M et al. Stroke risk in the early period after carotid related symptoms: a systematic review. J Cardiovasc Surg (Torino) 2015; 56 (6): 845–852.

11. Reznik M, Kamel H, Gialdini G et al. Timing of carotid revascularization procedures after ischemic stroke. Stroke 2017; 48 (1): 225–228. doi: 10.1161/STROKEAHA.116.015766.

12. Hurst K, Lee R, Sideso E et al. Delays in the presentation to stroke services of patients with transient ischaemic attack and minor stroke. Br J Surg 2016; 103 (11): 1462–1466. doi: 10.1002/bjs.10199.

13. Sharpe R, Sayers RD, London NJ et al. Procedural risk following carotid endarterectomy in the hyperacute period after onset of symptoms. Eur J Vasc Endovasc Surg 2013; 46 (5): 519–524. doi: 10.1016/j.ejvs.2013.08.014.

14. Rantner B, Schmidauer C, Knoflach M et al. Very urgent carotid endarterectomy does not increase the procedural risk. Eur J Vasc Endovasc Surg 2015; 49 (2): 129–136. doi: 10.1016/j.ejvs.2014.09.006.

15. Tsantilas P, Kühnl A, Kallmayer M et al. A short time interval between the neurologic index event and carotid endarterectomy is not a risk factor for carotid surgery. J Vasc Surg 2017; 65 (1): 12–20. doi: 10.1016/j.jvs.2016.07.116.

16. Tsivgoulis G, Krogias C, Georgiadis GS, et al. Safety of early endarterectomy in patients with symptomatic carotid artery stenosis: an international multicenter study. Eur J Neurol 2014; 21 (10): 1251–1257. doi: 10.1111/ene.12461.

17. Rerkasem K, Rothwell PM. Systematic review of the operative risks of carotid endarterectomy for recently symptomatic stenosis in relation to the timing of surgery. Stroke 2009; 40 (10): e564–e572. doi: 10.1161/STROKEAHA.109.558528.

18. Bruls S, Van Damme H, Defraigne JO. Timing of carotid endarterectomy: a comprehensive review. Acta Chir Belg 2012; 112 (1): 3–7. doi: 10.1080/00015458.2012.11680787.

19. Mracek J, Holeckova I, Mork J et al. The timing of carotid endarteretomy. Cesk Slov Neurol N 2008; 104/71 (4): 414–421.

20. Lanza G, Ricci S, Speziale F et al. SPREAD-STACI study: a protocol for a randomized multicenter clinical trial comparing urgent with delayed endarterectomy in symptomatic carotid artery stenosis. Int J Stroke 2012; 7 (1): 81–85. doi: 10.1111/j.1747-4949.2011.00699.x.