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Early Carotid Endarterectomy Recommended for Patients With TIA or Minor Stroke: Presented at ESC

By Michael J. Worthington

MANNHEIM-HEIDELBERG, GERMANY -- May 18, 2004 -- Carotid endarterectomy (CEA) should be performed as early as possible after TIA or minor stroke, according to a study reported here on May 14^th at the 13^th European Stroke Conference in Mannheim, Germany.

Studies dating back to the 1960s have indicated that CEA should not be performed until at least 30 days after onset of ischemic stroke. The reason, according to Dr. A.H. Jacobs, University of Cologne, Cologne, Germany, is that early CEA (within 15-30 days) was believed to increase the risk of reinfarction or secondary hemorrhage due to reperfusion trauma.

Recent studies, however, have shown that early CEA does not carry an increased perioperative risk.

To confirm the findings, Dr. Jacobs and colleagues conducted a retrospective study of 39 patients with symptomatic, high-grade intracranial arterial (ICA) stenosis due to minor (n=19) or major (n=6) stroke or TIA (n=14). Patients underwent CEA within 4 to 6 weeks of the event. The mean duration of symptoms before admission in these patients was 43.2 hours. In 29 patients ipsilateral high-grade ICA stenosis was treated early (within 3.9 days of admission); in 5 patients it was performed late (within 25.5 days).

The surgeons based their decision to carry out the procedure on duplex sonography alone in 35.9% of patients, duplex sonography with magnetic resonance imaging in 35.9%, and conventional angiography in 15.4%). In 20.5% of patients, the decision to operate was based on a PET scan diffusion-weighted imaging and T2-weighted imaging.

"The preoperative morbidity was determined by the deterioration before CEA," Dr. Jacobs said. "Although we were pretty fast, there were 2 patients in the early group who deteriorated before the operation was performed, compared to 1 patient in the late group."

Perioperative morbidity in the early group included impaired wound healing in 1 patient, clinical deterioration in 1, hemorrhage/seizure in 1. In the late group, 1 patient had a hemorrhage.

Dr. Jacobs said, "After non-disabling stroke, early CEA of ipsilateral high-grade ICA-stenosis can be performed with similar mortality and morbidity as late CEA. Therefore, after TIA or minor stroke, CEA should be performed as soon as possible. In patients with major stroke, one should perform CEA within 30 days."

He added that interdisciplinary patient selection is required to further reduce the risk of hemorrhage and stroke, especially in patients with greater than 90% stenosis, impaired autoregulation, or major stroke.


[Presentation title: Early endarterectomy of high-grade ICA stenosis after minor stroke.]

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