Pilot study of carotid surgery for acute stroke

Mead, Gillian; Murray, H; Farrell, Anne G.; O’Neill, Paul; McCollum, Charles

doi:10.1002/bjs.1800840723

Cited by 39 publications

(25 citation statements)

References 15 publications

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“…We attempted to create a homogenous cohort of patients with presumed ICA atherosclerotic stroke because atherosclerosis is by far the most common cause of ICA occlusion. 5,14,15 However, our methodology may have resulted in ascertainment bias and some patients with atherosclerotic disease may have been missed and other patients incorrectly included. Second, the vascular imaging modality used was not uniform, because it depended on participating hospital resources and treating physician preference.…”

Section: Discussionmentioning

confidence: 99%

Short-Term Outcomes After Symptomatic Internal Carotid Artery Occlusion

Burke

Vergouwen²,

Fang³

et al. 2011

Stroke

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Section: Discussionmentioning

confidence: 99%

Short-Term Outcomes After Symptomatic Internal Carotid Artery Occlusion

Burke

Vergouwen²,

Fang³

et al. 2011

Stroke

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“…13 Carotid artery atherosclerotic disease may account for up to 30% of all strokes. 16,22 Results in several clinical trials have shown a benefit for CEA over conservative medical management in preventing strokes in patients with CA stenosis. In 1991, the NASCET demonstrated a 17% absolute risk reduction for ipsilateral stroke over 2 years with endarterectomy compared with medical management in symptomatic patients with severe CA stenosis of at least 70%.…”

mentioning

confidence: 99%

Procedure complications of carotid angioplasty and stent placement without cerebral protection devices

Kadkhodayan¹,

Derdeyn²,

Cross³

et al. 2005

FOC

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Object The goal in this retrospective study was to examine the procedural complication rate for carotid angioplasty and stent placement performed without cerebral protection devices. Methods Between March 1996 and December 2003, 167 carotid angioplasty and/or stent placement procedures were performed without cerebral protection devices in 152 patients (57 women and 95 men whose mean age was 64 years, range 19–92 years). Seven of these patients underwent angioplasty alone. Eighty-nine patients presented with focal neurological symptoms. Indications for surgery included atherosclerosis, radiation-associated stenosis, dissection, pseudoaneurysm, and stretched endovascular coils from aneurysm treatment. In this study, the patients' medical records were reviewed for clinical characteristics, techniques used, and resulting intraprocedural and 30-day complication rates. The intraprocedural stroke rate was four (2.4%) of 167; this included three hemispheric strokes and one retinal embolus. All events occurred in patients who had symptomatic stenosis. The procedural transient ischemic complication rate was six (3.6%) of 167, as was the procedural nonneurological complication rate. During the 30 days post-procedure, one patient had died and three had suffered permanent ischemic events (two cerebral and one ocular). The composite 30-day postprocedural stroke and death rate was eight (5%) of 160. The rate of asymptomatic angiographically confirmed abnormalities was 0.6% (one treated vessel that was occluded but asymptomatic). The 30-day rate of nonneurological complications was 2.5%. A strong association between intraprocedural thromboembolic events (eight cases) and prior ischemic symptoms was found (p = 0.01). Conclusions Carotid angioplasty and stent placement without cerebral protection devices is safe, particularly in patients without symptomatic stenosis.

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“…Patients with PACI were also more likely than other categories of stroke to have a severe (>70%) carotid stenosis [8]. In a feasibility study for this trial, severe ipsilateral (70–99%) stenosis was found in 25 (20%) of 128 PACI patients [9]. Fifteen of these 40 patients were referred to in our feasibility study but were not analysed by randomised treatment.…”

Section: Introductionmentioning

confidence: 99%

Early Carotid Surgery in Acute Stroke: A Multicentre Randomised Pilot Study

Welsh¹,

Mead²,

Chant³

et al. 2004

Cerebrovasc Dis

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Background: Standard practice has been to delay carotid endarterectomy (CEA) for 2 months following acute stroke to avoid a perceived risk of cerebral haemorrhage. We investigated whether early CEA reduces early recurrent stroke and improves outcome in partial anterior circulation infarction (PACI). Methods: Patients with PACI and a Barthel score of >18 before stroke underwent carotid duplex and CT imaging within 7 days of stroke. Forty consenting patients fit for surgery with greater than 70% ipsilateral carotid stenosis were randomised, 19 to ‘early’ (within 24 h) and 21 to ‘delayed’ surgery (at 8 weeks). Modified Rankin and Barthel scores were recorded at 1 week, 2 months, 6 and 12 months. Results: Rankin scores improved more rapidly following ‘early’ surgery to a score of 1 (0–4) at 2 and 6 months compared with 2.5 and 2 (1–4), respectively, for delayed surgery (p < 0.05). Barthel scores were also significantly improved following ‘early’ CEA at 7 days but both groups reached a median score of 20 by 2 months. Four ‘delayed’ and 3 ‘early’ patients suffered extension or recurrence of neurological deficits with 1 death in each group. Conclusions: Early CEA within 7 days of ischaemic stroke improved functional outcome with earlier hospital discharge. A large multicentre study is needed to exclude the possibility that ‘early’ CEA increases the risk of cerebral haemorrhage or death.

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Pilot study of carotid surgery for acute stroke

Abstract: A definitive trial of urgent carotid surgery would need to screen large numbers of patients but could focus on patients with partial anterior circulation infarcts.

Cited by 39 publications

References 15 publications

Short-Term Outcomes After Symptomatic Internal Carotid Artery Occlusion

Short-Term Outcomes After Symptomatic Internal Carotid Artery Occlusion

Procedure complications of carotid angioplasty and stent placement without cerebral protection devices

Early Carotid Surgery in Acute Stroke: A Multicentre Randomised Pilot Study

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