Peripheral Vascular Surgery Society

Purpose: Although there are several reports suggesting the safety of performing carotid endarterectomy (CEA) within 4 weeks (early) of a non-disabling stroke, at many institutions it is not standard practice. Benefits of early surgery may include reduction in the number of strokes or carotid occlusions during the time between stroke and surgery, as well as a reduction in the cost of medical care due to the elimination of interval anticoagulation and close follow-up. This review examines the outcomes of early CEA in selected patients after a non-disabling stroke.

Methods: 786 CEAs were performed between November, 1991 and December, 1996. 66 patients were identified by computerized hospital record and office chart review as having CEA after a non-disabling stroke. Criteria for early surgery included: 1) non-disabling stroke ipsilateral to a carotid stenosis greater than 50%, 2) neurologically stable, 3) no evidence of hemorrhagic stroke or significant cerebral edema by CT/MRI evaluation.

Results: 45 patients (early group) had surgery within 30 days of stroke (range 1-23 days, mean 10 ± 7) and 20 patients (delayed group ) had surgery more than 30 days after stroke (range 33-205 days, mean 62 ± 27; p>0.001). The perioperative stroke rate was similar for both the early and delayed groups, 4.3% vs. 5.0% (relative risk = 0.86, 95% CI, 0.084-9.048; p=1.0). Similarly, the perioperative myocardial infarction and mortality rates were not significantly different for the early group, despite having significantly more patients with two or more medical co-morbidities (65% vs. 37%, p=0.04). Within the early group, the time from stroke to surgery was significantly shorter at the end of the study period (1996) than in the beginning (1992) (5.7 vs. 14 days, p=0.05).

Conclusion: This review suggests that early CEA can be performed in selected patients with an acceptable perioperative morbidity and mortality.