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Early Carotid Endarterectomy Provides a Better Neurological Outcome in Symptomatic Patients: A Single-Center Experience.

Abstract：

BACKGROUND:Many studies confirmed the role of early carotid endarterectomy (CEA) to prevent recurrent stroke or transient ischemic attack; however, the mid-long-term neurological benefit is still not completely investigated. The purpose of the study was to evaluate the role of early CEA on the perioperative and postoperative stroke/death complications of patients with a symptomatic carotid stenosis. METHODS:Ninety consecutive patients were referred to our center for a symptomatic carotid stenosis. They were divided into 2 groups according to the time to surgery: G1 within 2 weeks (39 patients) and G2 from 2 weeks to thereafter (51 patients). Neurological assessment was performed with the National Institutes of Health Stroke Scale (NIHSS) at presentation and at follow-up. Echo color Doppler ultrasound was performed at 1-6 months and then yearly. RESULTS:The presentation of neurological symptoms differed significantly between the 2 groups; in fact, minor stroke was more frequent in G1, whereas transient ischemic attack was more frequent in G2 (P value = 0.027). No significant differences emerged between the 2 groups on the surgical intervention or perioperative complications. The study showed a significant improvement of the neurological impairment (evaluated with a reduction of NIHSS score) of patients in G1 compared with G2 (P value = 0.01). CONCLUSIONS:Neurological recovery after a symptomatic carotid stenosis is strictly correlated to the variable "time to surgery." A higher sensitization of the general population on the early recognition of the symptoms and a strict collaboration with neurologists is mandatory to reduce time to CEA and improve clinical outcomes.

journal_name

Ann Vasc Surg

journal_title

Annals of vascular surgery

authors

Varetto G,Gibello L,Sperti F,Trevisan A,Frola E,Garneri P,Rispoli P

doi

10.1016/j.avsg.2017.05.016

subject

Has Abstract

pub_date

2017-11-01 00:00:00

pages

62-68

eissn

0890-5096

issn

1615-5947

pii

S0890-5096(17)30018-3

journal_volume

45

pub_type

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