Early Carotid Surgery in Patients After Acute Ischemic Stroke: Is it Safe? A Retrospective Analysis in a Single Center Between Early and Delayed/Deferred Carotid Surgery on 285 Patients

Ferrero, Emanuele; Ferri, Michelangelo; Viazzo, Andrea; Gaggiano, Andrea; Ferrero, Mauro; D, Maggio; Berardi, Giuseppe; Pecchio, Alberto; Piazza, Salvatore; Cumbo, Pia; Nessi, Franco

doi:10.1016/j.avsg.2010.03.014

Cited by 30 publications

(10 citation statements)

References 26 publications

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“…Ferrero et al reported that the early risk of secondary stroke after transient ischemic attack (TIA)/stroke is approximate 5–10% at 1 week and 10–20% at 3 months [23]. In this study, we also found that the delayed CAS group had a higher rate of second rate stroke compared to that of early CAS group (12.3% versus 3.2%).…”

Section: Discussionsupporting

confidence: 67%

Clinical Comparison of Outcomes of Early versus Delayed Carotid Artery Stenting for Symptomatic Cerebral Watershed Infarction due to Stenosis of the Proximal Internal Carotid Artery

Liu

Chu

Zhang

et al. 2016

BioMed Research International

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The aim of this study was to compare the clinical outcomes of early versus delayed carotid artery stenting (CAS) for symptomatic cerebral watershed infarction (sCWI) patients due to stenosis of the proximal internal carotid artery. We retrospectively collected clinical data of those who underwent early or delayed CAS from March 2011 to April 2014. The time of early CAS and delayed CAS was within a week of symptom onset and after four weeks from symptom onset. Clinical data such as second stroke, the National Institutes of Health Stroke Scale (NHISS) score, and modified Rankin Scale (mRS) score and periprocedural complications were collected. The rate of second stroke in early CAS group is lower when compared to that of delayed CAS group. There was no significant difference regarding periprocedural complications in both groups. There was a significant difference regarding mean NHISS score 90 days after CAS in two groups. Early CAS group had a significant better good outcome (mRS score ≤ 2) than delayed CAS group. We suggest early CAS for sCWI due to severe proximal internal carotid artery stenosis as it provides lower rate of second stroke, comparable periprocedural complications, and better functional outcomes compared to that of delayed CAS.

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Section: Discussionsupporting

confidence: 67%

Clinical Comparison of Outcomes of Early versus Delayed Carotid Artery Stenting for Symptomatic Cerebral Watershed Infarction due to Stenosis of the Proximal Internal Carotid Artery

Liu

Chu

Zhang

et al. 2016

BioMed Research International

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“…Carotid endarterectomy for stroke in progress carries a high operative risk, but as soon as a patient with stroke or TIA is stable, very early CA intervention might be beneficial (JF Meschia, et al, presentation to the American Academy of Neurology Annual Meeting, 2011). 7,9,13,29 However, data from the Swedish Vascular Registry on 2596 CEA patients with symptomatic CA disease show that patients treated within 0-2 days after the qualifying neurological event have a significantly increased perioperative risk compared with patients treated after 3-7 days, 8-14 days, or 15-180 days (11.5% vs 3.6%, 4.0%, or 5.4%, respectively; p < 0.001).…”

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confidence: 99%

“…However, this is a highly controversial issue. 13,17,19,30,33,34 If surgery is performed immediately or within the first days of the onset of symptoms, the risk of stroke in the natural history has to be weighed against the risk of very early surgery, and the risk of very early surgery might differ from that of surgery at a later time. Carotid endarterectomy for stroke in progress carries a high operative risk, but as soon as a patient with stroke or TIA is stable, very early CA intervention might be beneficial (JF Meschia, et al, presentation to the American Academy of Neurology Annual Meeting, 2011).…”

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confidence: 99%

Risk of very early recurrent cerebrovascular events in symptomatic carotid artery stenosis

Mono¹,

Steiger²,

Findling³

et al. 2013

JNS

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Object The risk of recurrence of cerebrovascular events within the first 72 hours of admission in patients hospitalized with symptomatic carotid artery (CA) stenoses and the risks and benefits of emergency CA intervention within the first hours after the onset of symptoms are not well known. Therefore, the authors aimed to assess 1) the ipsilateral recurrence rate within 72 hours of admission, in the period from 72 hours to 7 days, and after 7 days in patients presenting with nondisabling stroke, transient ischemic attack (TIA), or amaurosis fugax (AF), and with an ipsilateral symptomatic CA stenosis of 50% or more, and 2) the risk of stroke in CA interventions within 48 hours of admission versus the risk in interventions performed after 48 hours. Methods Ninety-four patients were included in this study. These patients were admitted to hospital within 48 hours of a nondisabling stroke, TIA, or AF resulting from a symptomatic CA stenosis of 50% or more. The patients underwent carotid endarterectomy (85 patients) or CA stenting (9 patients). At baseline, the cardiovascular risk factors of the patients, the degree of symptomatic CA stenosis, and the type of secondary preventive treatment were assessed. The in-hospital recurrence rate of stroke, TIA, or AF ipsilateral to the symptomatic CA stenosis was determined for the first 72 hours after admission, from 72 hours to 7 days, and after 7 days. Procedure-related cerebrovascular events were also recorded. Results The median time from symptom onset to CA intervention was 5 days (interquartile range 3.00–9.25 days). Twenty-one patients (22.3%) underwent CA intervention within 48 hours after being admitted. Overall, 15 recurrent cerebrovascular events were observed in 12 patients (12.8%) in the period between admission and CA intervention: 3 strokes (2 strokes in progress and 1 stroke) (3.2%), 5 TIAs (5.3%), and 1 AF (1.1%) occurred within the first 72 hours (total 9.6%) of admission; 1 TIA (1.1%) occurred between 72 hours and 7 days, and 5 TIAs (5.3%) occurred after more than 7 days. The corresponding actuarial cerebrovascular recurrence rates were 11.4% (within 72 hours of admission), 2.4% (between 72 hours and 7 days), and 7.9% (after 7 days). Among baseline characteristics, no predictive factors for cerebrovascular recurrence were identified. Procedure-related cerebrovascular events occurred at a rate of 4.3% (3 strokes and 1 TIA), and procedures performed within the first 48 hours and procedures performed after 48 hours had a similar frequency of these events (4.5% vs 4.1%, respectively; p = 0.896). Conclusions The in-hospital recurrence of cerebrovascular events was quite low, but all recurrent strokes occurred within 72 hours. The risk of stroke associated with a CA intervention performed within the first 48 hours was not increased compared with that for later interventions. This raises the question of the optimal timing of CA intervention in symptomatic CA stenosis. To answer this question, more data are needed, preferably from large randomized trials.

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“…Rockman et al [12] reported a higher rate (5.1%) of perioperative stroke in the early CEA group than in the delayed CEA group (1.6%). Emanuele [13 ]showed in a retrospective analysis that early CEA can reduce the recurrent strokes and does not result in greater complications than when performed delayed. Recent American Heart Association and American Academy of Neurology guidelines [14,15] advocate that CEA should be performed within 2 weeks of the index event in patients with symptomatic carotid artery stenosis [16].…”

Section: Discussionmentioning

confidence: 99%

Early Carotid Artery Stenting for Cerebral Watershed Infarction Is Safe and Effective: A Retrospective Study

Liu

Chu²,

Zhang³

et al. 2016

Eur Neurol

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Background: With carotid artery stenosis, infarcts can occur in the cortical or internal watershed areas, or both. The timing of carotid artery stenting (CAS) after a cerebral watershed infarction (CWI) is not yet codified. In this retrospective study, we analyzed the safety and clinical effect of early CAS for CWI patients due to carotid artery stenosis. Methods: Between March 2011 and April 2014, 120 CWI patients with ipsilateral carotid artery stenosis were recruited. Of these 120 patients, 63 received CAS within 7 days of the symptom onset (group 1) and 57 received standard medical treatment at the symptom onset (group 2). Periprocedural complications were analyzed in group 1 to evaluate the safety of early CAS. Clinical effects were analyzed by evaluating National Institutes of Health Stroke Scale (NIHSS) score as well as modified Ranking Scale (mRS) score of pre- and post-treatment in 2 groups. Results: There was no significant difference in pre-treatment NIHSS score between the 2 groups (8.52 ± 2.46 and 7.84 ± 2.64, p = 0.15). However, group 1 had lower post-treatment NIHSS score as compared to group 2 (3.03 ± 1.44 and 3.84 ± 1.73, p = 0.006). In both groups, NIHSS score after treatment was significantly reduced (p < 0.05). Treatment effect in group 1 was larger compared to group 2 (-5.49 ± 2.12 and -4.00 ± 1.98, p < 0.05). Before the treatment, both groups had similar patient numbers with mRS score ≤2; however, after 30 days of surgery, group 1 had more number of patients with mRS score ≤2 than group 2. Conclusion: This study suggested that early CAS for CWI can be performed without significant risk. More importantly, early CAS for CWI can improve the prognosis.

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Early Carotid Surgery in Patients After Acute Ischemic Stroke: Is it Safe? A Retrospective Analysis in a Single Center Between Early and Delayed/Deferred Carotid Surgery on 285 Patients

Cited by 30 publications

References 26 publications

Clinical Comparison of Outcomes of Early versus Delayed Carotid Artery Stenting for Symptomatic Cerebral Watershed Infarction due to Stenosis of the Proximal Internal Carotid Artery

Clinical Comparison of Outcomes of Early versus Delayed Carotid Artery Stenting for Symptomatic Cerebral Watershed Infarction due to Stenosis of the Proximal Internal Carotid Artery

Risk of very early recurrent cerebrovascular events in symptomatic carotid artery stenosis

Early Carotid Artery Stenting for Cerebral Watershed Infarction Is Safe and Effective: A Retrospective Study

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