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Immediate CEA for symptomatic carotid disease preferably performed under local anaesthesia is safe.
Vasa. 2007 Aug; 36(3):185-90.VASA

Abstract

BACKGROUND

Previous general reservations against carotid endarterectomy (CEA) early after stroke, which were primarily based on concerns of postoperative intracerebral hemorrhage, are resolved. Moreover, a delay of surgery is proofed to be associated with a risk of recurrent cerebral ischemia. However, the complication rate of CEA seems to increase with less time interval to the onset of symptoms. The main purpose of this study was to assess the safety of very early CEA.

PATIENTS AND METHODS

Patients having a symptomatic high-grade (> 70%) internal carotid artery (ICA) stenosis were referred by neurologists for CEA within different timeframes, so that they were later differentiated depending on whether surgery was performed within 2 days (immediate CEA = iCEA) or 2 weeks (urgent CEA = uCEA) after neurological deficits have occurred primarily. The perioperative complication rate in these groups was than evaluated and compared.

RESULTS

From January 2000 until August 2006 130 consecutive patients (median age 68 years, range: 42-90; 66% male, 34%female)presenting with an ipsilateral TIA (n = 80), stroke (n = 50) underwent iCEA (n = 40) or uCEA (n = 90). Demographic and clinical characteristics were equally distributed between treatment groups. Mostly (121/130), CEA was performed under local anaesthesia with selective shunt use which became necessary in 26%. Besides postoperative hemorrhage (n = 4), cardiac complications (n = 2) and temporary cranial nerve lesions (n = 2), new perioperative neurological deficits occurred in total in 8 patients of which 6 were temporary. The other 2 patients developed strokes of which one patient died. Therefore, the combined stroke- and mortality rate was 1.5% (2/130) for the whole study population. With regard to the timing of surgery, a single incident was observed after iCEA (1/40) which also was the only intracerebral hemorrhage.

CONCLUSIONS

It seems that patients with a symptomatic high-grade ICA stenosis can undergo CEA particularly under local anaesthesia as soon as possible without anticipating an increased complication rate.

Authors+Show Affiliations

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

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

18019275

Citation

Aleksic, M, et al. "Immediate CEA for Symptomatic Carotid Disease Preferably Performed Under Local Anaesthesia Is Safe." VASA. Zeitschrift Fur Gefasskrankheiten, vol. 36, no. 3, 2007, pp. 185-90.
Aleksic M, Rueger MA, Sobesky J, et al. Immediate CEA for symptomatic carotid disease preferably performed under local anaesthesia is safe. VASA. 2007;36(3):185-90.
Aleksic, M., Rueger, M. A., Sobesky, J., Heckenkamp, J., Jacobs, A. H., & Brunkwall, J. (2007). Immediate CEA for symptomatic carotid disease preferably performed under local anaesthesia is safe. VASA. Zeitschrift Fur Gefasskrankheiten, 36(3), 185-90.
Aleksic M, et al. Immediate CEA for Symptomatic Carotid Disease Preferably Performed Under Local Anaesthesia Is Safe. VASA. 2007;36(3):185-90. PubMed PMID: 18019275.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Immediate CEA for symptomatic carotid disease preferably performed under local anaesthesia is safe. AU - Aleksic,M, AU - Rueger,M A, AU - Sobesky,J, AU - Heckenkamp,J, AU - Jacobs,A H, AU - Brunkwall,J, PY - 2007/11/21/pubmed PY - 2007/12/7/medline PY - 2007/11/21/entrez SP - 185 EP - 90 JF - VASA. Zeitschrift fur Gefasskrankheiten JO - VASA VL - 36 IS - 3 N2 - BACKGROUND: Previous general reservations against carotid endarterectomy (CEA) early after stroke, which were primarily based on concerns of postoperative intracerebral hemorrhage, are resolved. Moreover, a delay of surgery is proofed to be associated with a risk of recurrent cerebral ischemia. However, the complication rate of CEA seems to increase with less time interval to the onset of symptoms. The main purpose of this study was to assess the safety of very early CEA. PATIENTS AND METHODS: Patients having a symptomatic high-grade (> 70%) internal carotid artery (ICA) stenosis were referred by neurologists for CEA within different timeframes, so that they were later differentiated depending on whether surgery was performed within 2 days (immediate CEA = iCEA) or 2 weeks (urgent CEA = uCEA) after neurological deficits have occurred primarily. The perioperative complication rate in these groups was than evaluated and compared. RESULTS: From January 2000 until August 2006 130 consecutive patients (median age 68 years, range: 42-90; 66% male, 34%female)presenting with an ipsilateral TIA (n = 80), stroke (n = 50) underwent iCEA (n = 40) or uCEA (n = 90). Demographic and clinical characteristics were equally distributed between treatment groups. Mostly (121/130), CEA was performed under local anaesthesia with selective shunt use which became necessary in 26%. Besides postoperative hemorrhage (n = 4), cardiac complications (n = 2) and temporary cranial nerve lesions (n = 2), new perioperative neurological deficits occurred in total in 8 patients of which 6 were temporary. The other 2 patients developed strokes of which one patient died. Therefore, the combined stroke- and mortality rate was 1.5% (2/130) for the whole study population. With regard to the timing of surgery, a single incident was observed after iCEA (1/40) which also was the only intracerebral hemorrhage. CONCLUSIONS: It seems that patients with a symptomatic high-grade ICA stenosis can undergo CEA particularly under local anaesthesia as soon as possible without anticipating an increased complication rate. SN - 0301-1526 UR - https://www.unboundmedicine.com/medline/citation/18019275/Immediate_CEA_for_symptomatic_carotid_disease_preferably_performed_under_local_anaesthesia_is_safe_ L2 - http://econtent.hogrefe.com/doi/full/10.1024/0301-1526.36.3.185?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -