Carotid Endarterectomy in Symptomatic Patients – Challenges of Implementing International Guidelines in an Indian Setting

Gupta, Prem Chand; Venugopal, K.; Sharma, Pritee; Atturu, Gnaneswar

doi:10.1016/j.ejvs.2019.09.349

Cited by 1 publication

(1 citation statement)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Since patients recover completely after a TIA, they may not appreciate the gravity of the situation and often ignore it until they have a stroke. An Indian study had previously reported that the lack of recognition of stroke symptoms by the patients, delay in seeking medical care and referral to a stroke neurologist or vascular surgeon, delay in decision-making for the procedure, getting a second opinion from another specialist, and financial constraints were factors contributing to delay in endarterectomy [17]. A study from Pakistan reported that 15% of patients were not aware of a surgical option for carotid stenosis [18].…”

Section: Discussionmentioning

confidence: 99%

Carotid Endarterectomy for Symptomatic Carotid Stenosis: Differences in Patient Profile in a Low-Middle-Income Country

Paramasivan

Sylaja

Pitchai

et al. 2022

Cerebrovasc Dis Extra

View full text Add to dashboard Cite

Introduction: Carotid Endarterectomy (CEA) is the standard treatment for patients with symptomatic carotid stenosis. Data from Low- and Middle-Income Countries (LMIC) is sparse on CEA and its outcomes. We aimed to describe the profile of our patients, and factors associated with periprocedural cerebral ischemic events in patients with symptomatic carotid stenosis who underwent CEA in our institute. Methods: Retrospective review of patients with symptomatic carotid stenosis(50-99%) who underwent CEA between January 2011 and December 2021 was done. Clinical and imaging parameters and their influence on periprocedural cerebral ischemic events were analysed. Results: Of the 319 patients (77% males) with a mean age of 64 years (SD ±8.6), 207 (65%) presented only after a stroke. Majority (85%) had high grade stenosis (70%) of the symptomatic carotid. The mean time to CEA was 50 days (SD ±36), however only 26 patients (8.2%) underwent surgery within 2 weeks. Minor strokes and TIA occurred in 2.2%, while major strokes and death occurred in 4.1% patients. None of the clinical or imaging parameters predicted the periprocedural cerebral ischemic events. The presence of co-existing significant (50%) tandem intracranial atherosclerosis (n=77, 24%) or contralateral occlusion (n=24, 7.5%) did not influence the periprocedural stroke risk. Conclusion: There is a delay in patients undergoing CEA for symptomatic carotid stenosis. Majority have high grade stenosis and present late only after a stroke reflecting a lack of awareness. CEA can be performed safely even in patients with significant intracranial tandem stenosis and contralateral carotid occlusion.

show abstract

Section: Discussionmentioning

confidence: 99%