Timing of carotid endarterectomy after stroke.

Abstract:

BACKGROUND:Timing of carotid endarterectomy after stroke in a patient with a fixed neurological deficit remains an important but unresolved question. Early surgery has been associated with cerebral hemorrhage and infarct extension. Delayed endarterectomy exposes the patient to recurrent stroke and carotid occlusion. This review investigates the hypothesis that timing of surgery after stroke influences outcome and complications. SUMMARY OF REVIEW:This analysis critically evaluates peer-reviewed reports that retrospectively examined outcome after surgery performed "early" and "late" after stroke. The basis for intracerebral hemorrhage after endarterectomy is discussed. Clinical features that influence outcome are investigated. CONCLUSIONS:Patients undergoing carotid endarterectomy are considered a heterogeneous group based on the following features: presence of low density on cranial CT, vascular territory of the infarct, brain shift, and level of consciousness. While critical review of these retrospective studies suggests that some patients with an acute stroke can safely undergo endarterectomy shortly after the diagnosis is made, direct answers to these questions of timing of endarterectomy after stroke are best addressed by prospective studies. Nevertheless, the present review provides a basis for decision making in certain patients and for the design of future investigations.

journal_name

Stroke

journal_title

Stroke

authors

Pritz MB

doi

10.1161/01.str.28.12.2563

subject

Has Abstract

pub_date

1997-12-01 00:00:00

pages

2563-7

issue

12

eissn

0039-2499

issn

1524-4628

journal_volume

28

pub_type

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