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Primary stroke unit treatment followed by very early carotid endarterectomy for carotid artery stenosis after acute stroke.
Cerebrovasc Dis. 2006; 22(4):276-81.CD

Abstract

BACKGROUND

Although it is recognized that carotid endarterectomy (CEA) is the treatment of choice in symptomatic internal carotid artery (ICA) stenosis, in the past, very early CEA has been shown to carry substantial risks. We assessed an interdisciplinary concept of very early CEA in patients with high-grade (>70%) symptomatic ICA stenosis at a single center.

PATIENTS AND METHODS

The course of treatment and outcomes of patients who underwent CEA as early as possible after being referred to the stroke unit for symptoms of transient ischemic attack and stroke were prospectively evaluated, including the following parameters: age, severity of ischemia-related symptoms according to the modified Rankin scale, duration of symptoms until admission, multimodal imaging findings (color-coded duplex, cranial computed tomography, magnetic resonance imaging, positron emission tomography), duration until CEA, perioperative course and complications, as well as duration of in-hospital care.

RESULTS

Fifty consecutive patients (median age 68 years, range 44-90) with clinical and imaging signs of transient ischemic attack (n = 19) or stroke (n = 31) were included from January 2000 until December 2004. All except 1 patient showed a preoperative Rankin < 4. There was a median time period of 6 h between the onset of symptoms and admission (range 1 h to 15 days) and a median duration of 4 days after admission until operation (range 1-21 days). Seven patients underwent CEA of the contralateral, severely stenosed ICA after symptomatic ipsilateral ICA occlusion. Four out of 5 patients who primarily underwent systemic thrombolysis recovered almost completely. Three patients (6%) experienced a clinical deterioration before surgery. In the majority of patients (43/50), CEA was performed under local anesthesia with selective shunt use which became necessary in 26%. Three patients (6%) had postoperative worsening due to new infarcts. In 2 cases, an intracerebral hemorrhage occurred, of which 1 remained asymptomatic. In 1 case, surgical revision was necessary because of an ICA thrombosis without permanent neurological decline. Patients were discharged after a median time of 14.5 days (range 4-44).

CONCLUSIONS

After careful selection and preparation in a stroke unit, patients with acute stroke due to carotid stenosis can undergo very early CEA under local anesthesia with a perioperative risk comparable with the risk of later endarterectomy, therefore preventing very early stroke recurrences.

Authors+Show Affiliations

Division of Vascular Surgery, Department of Visceral and Vascular Surgery, University Clinic of Cologne, Cologne, Germany. Marko.Aleksic@uk-koeln.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16788302

Citation

Aleksic, M, et al. "Primary Stroke Unit Treatment Followed By Very Early Carotid Endarterectomy for Carotid Artery Stenosis After Acute Stroke." Cerebrovascular Diseases (Basel, Switzerland), vol. 22, no. 4, 2006, pp. 276-81.
Aleksic M, Rueger MA, Lehnhardt FG, et al. Primary stroke unit treatment followed by very early carotid endarterectomy for carotid artery stenosis after acute stroke. Cerebrovasc Dis. 2006;22(4):276-81.
Aleksic, M., Rueger, M. A., Lehnhardt, F. G., Sobesky, J., Matoussevitch, V., Neveling, M., Heiss, W. D., Brunkwall, J., & Jacobs, A. H. (2006). Primary stroke unit treatment followed by very early carotid endarterectomy for carotid artery stenosis after acute stroke. Cerebrovascular Diseases (Basel, Switzerland), 22(4), 276-81.
Aleksic M, et al. Primary Stroke Unit Treatment Followed By Very Early Carotid Endarterectomy for Carotid Artery Stenosis After Acute Stroke. Cerebrovasc Dis. 2006;22(4):276-81. PubMed PMID: 16788302.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Primary stroke unit treatment followed by very early carotid endarterectomy for carotid artery stenosis after acute stroke. AU - Aleksic,M, AU - Rueger,M A, AU - Lehnhardt,F G, AU - Sobesky,J, AU - Matoussevitch,V, AU - Neveling,M, AU - Heiss,W D, AU - Brunkwall,J, AU - Jacobs,A H, Y1 - 2006/06/20/ PY - 2005/10/20/received PY - 2006/03/24/accepted PY - 2006/6/22/pubmed PY - 2006/11/2/medline PY - 2006/6/22/entrez SP - 276 EP - 81 JF - Cerebrovascular diseases (Basel, Switzerland) JO - Cerebrovasc. Dis. VL - 22 IS - 4 N2 - BACKGROUND: Although it is recognized that carotid endarterectomy (CEA) is the treatment of choice in symptomatic internal carotid artery (ICA) stenosis, in the past, very early CEA has been shown to carry substantial risks. We assessed an interdisciplinary concept of very early CEA in patients with high-grade (>70%) symptomatic ICA stenosis at a single center. PATIENTS AND METHODS: The course of treatment and outcomes of patients who underwent CEA as early as possible after being referred to the stroke unit for symptoms of transient ischemic attack and stroke were prospectively evaluated, including the following parameters: age, severity of ischemia-related symptoms according to the modified Rankin scale, duration of symptoms until admission, multimodal imaging findings (color-coded duplex, cranial computed tomography, magnetic resonance imaging, positron emission tomography), duration until CEA, perioperative course and complications, as well as duration of in-hospital care. RESULTS: Fifty consecutive patients (median age 68 years, range 44-90) with clinical and imaging signs of transient ischemic attack (n = 19) or stroke (n = 31) were included from January 2000 until December 2004. All except 1 patient showed a preoperative Rankin < 4. There was a median time period of 6 h between the onset of symptoms and admission (range 1 h to 15 days) and a median duration of 4 days after admission until operation (range 1-21 days). Seven patients underwent CEA of the contralateral, severely stenosed ICA after symptomatic ipsilateral ICA occlusion. Four out of 5 patients who primarily underwent systemic thrombolysis recovered almost completely. Three patients (6%) experienced a clinical deterioration before surgery. In the majority of patients (43/50), CEA was performed under local anesthesia with selective shunt use which became necessary in 26%. Three patients (6%) had postoperative worsening due to new infarcts. In 2 cases, an intracerebral hemorrhage occurred, of which 1 remained asymptomatic. In 1 case, surgical revision was necessary because of an ICA thrombosis without permanent neurological decline. Patients were discharged after a median time of 14.5 days (range 4-44). CONCLUSIONS: After careful selection and preparation in a stroke unit, patients with acute stroke due to carotid stenosis can undergo very early CEA under local anesthesia with a perioperative risk comparable with the risk of later endarterectomy, therefore preventing very early stroke recurrences. SN - 1015-9770 UR - https://www.unboundmedicine.com/medline/citation/16788302/Primary_stroke_unit_treatment_followed_by_very_early_carotid_endarterectomy_for_carotid_artery_stenosis_after_acute_stroke_ L2 - https://www.karger.com?DOI=10.1159/000094016 DB - PRIME DP - Unbound Medicine ER -