Title : Urgent carotid endarterectomy after acute stroke
Abstract:
Early intervention within 2 weeks of symptom onset has been advocated and become standard of care for most patients with transient ischemic attacks. The optimal timing of carotid endarterectomy after a recent ischemic stroke is a subject of controversy because of a presumed high risk for intracerebral bleedings. Accepted practice in many centers is to wait 4 to 6 weeks after the onset of the deficit before proceeding with carotid endarterectomy because of the fear that early revascularization will increase the size of the infarct.
New data suggest that carotid revascularization can be safely performed within the first week (0–7 days) from symptom onset to prevent the peak of early recurrence without intervention. Urgent carotid endarterectomy (<48 hours after symptoms) may be associated with increased periprocedural stroke risks, especially in high risk patients. However, there are insufficient data on the natural history and the clinical instability of this subgroup of patients to assess the benefits and risk exposure of delaying treatment. Some studies reports their 2-day risk of stroke may be as high as 5.2%, 14-day risk may be as high as 11%, and the 90-day risk of stroke ranges between 20% and 30%. Urgent carotid endarterectomy, within 48 hours from the index neurological event, has been promoted by some reports to prevent the peak of recurrences during this first hours.
Probably in the future, the effect of modern, more intensive medical therapy good intraoperative monitoring by transcranial electroencephalography, cerebral oximeter and transcranial color Doppler and aggressively control blood pressure in intensive care unit, Urgent carotid endarterectomy, more will be.
In our study urgent carotid endarterectomy is safe in selected patients. All patients underwent preoperative bilateral carotid artery duplex examination and were found to have stenosis 70% and more (NASCET criteria). Patients received either a CT or MRI of the neck and brain to assess the carotid and cerebral circulation and the presence, location, and size of any infarct. All patients in stable neurological condition with minor stroke were inclusion criteria.
Audience take away:
The optimal time of carotid endarterectomy after stroke. 2-Carotid endarterectomy with lowest complication.3- Perioperative care and monitoring for carotid endarterectomy.
