TITLE:
Timing of Carotid Endarterectomy: Perioperative Outcome According to Index Event to Operation Room Time
AUTHORS:
Mehmet Kalender, Ahmet Nihat Baysal, Ata Niyazi Ecevit, Okay Güven Karaca, Mehmet Tasar, Salih Salihi
KEYWORDS:
Cerebrovascular Event, Carotid Artery Stenosis, Endarterectomy
JOURNAL NAME:
Surgical Science,
Vol.5 No.10,
October
10,
2014
ABSTRACT: Aim:Carotid endarterectomy (CEA) is the
choice of treatment for prevention of cerebrovascular events in vulnerable
patients. In this single-center multi surgeon study, we aimed to evaluate
outcomes of neurologically stable patients who underwent CEA after symptoms of
cerebrovascularevent according
to time between the event and operation.Methods:In our clinic during 2008-2012,we applied 67 CEA to 65 patients. Ten
of these 65 patients excluded from trial due to combined CABG operation. 18
patients were asymptomatic prior to operation and excluded. Thirty-nine of
these patients were symptomatic and enrolled to study. Data were collected
retrospectively. All enrolled patients were divided into two groups, according
to the time between event and operation. Group I: Early Group (≤14 days).Group II: Late Group (>14 days).
Results:In our clinic during
2008-2012, we applied 39 CEA procedures to consecutive 37 patients with
symptomatic carotid artery stenosis. None of preoperative variables were
associated with postoperative mortality (p > 0.05). We observed
postoperative bleeding in one patient who was in Late Group (II). Postoperative
bleeding was only associated with hyperlipidemia (p = 0.003). Postoperative
stroke was observed in moderate cardiac risk patients in Early Group (I) (p =
0.003). But none of the postoperative complications were associated with study
groups. We observed that, closure technique (primary closure) was associated
with postoperative stroke (p = 0.030). We have achieved shorter waiting time
during study time phrase but it couldn’t reached statistical significance (p =
0.196).Conclusion:Although symptomatic patients have a
higher risk of perioperative complications compared with asymptomatic patients,
early CEA after symptom onset does not influence the results. This raises the
question of the optimal timing of Carotid Artery intervention in symptomatic
carotid artery stenosis. To answer this question, more data are needed
preferably from large randomized trials.