Urgent Carotid Endarterectomy Does Not Increase Risk and Will Prevent More Strokes

Timing of carotid endarterectomy and clinical outcomes

“…The findings from these trials translated into grade A recommendations from the American Heart Association guidelines for performing CEA for symptomatic 70-99% carotid artery stenosis within 6 months of an ipsilateral non-disabling carotid artery ischaemic event (5). Delaying operative intervention for 6-8 weeks after a cerebral event was thought to be beneficial at that time due to the perceived increased risk of haemorrhagic transformation and increased peri-procedural risk together with the belief that delaying CEA would allow the carotid plaque to stabilise (6,7). Further evidence from Review Article on Carotid Artery Stenosis and Stroke: Prevention and Treatment Part I pooled analysis of NASCET and ECST demonstrated contrary evidence (8).…”

“…Beyond 2 weeks, the benefit of CEA fell dramatically for men with >69% stenosis. The 5-year absolute risk reduction was 30.2% with a number needed to treat (NNT) of 3 to prevent 1 ipsilateral stroke if CEA was performed within 2 weeks (7). The NNT doubles to 6 if CEA is delayed between 2-4 weeks (7).…”

“…The 5-year absolute risk reduction was 30.2% with a number needed to treat (NNT) of 3 to prevent 1 ipsilateral stroke if CEA was performed within 2 weeks (7). The NNT doubles to 6 if CEA is delayed between 2-4 weeks (7). In females, benefit was only seen by performing CEA for >69% stenosis within 2 weeks (8).…”

“…Naylor contextualised the argument for early (within 2 weeks) CEA with insights from a re-analysis of NASCET (12), ECST (13) and the Veteran Affairs trial (14). This analysis suggests that if CEAs are performed within 2 weeks even with a 10% perioperative stroke risk, at 5 years more strokes will have been prevented than by delaying CEA beyond 4 weeks with an associated 0% perioperative stroke risk (7,15).…”

Doença aterosclerótica carotídea

“…A detailed assessment of neurological status and the clinical repercussions could provide a basis for choosing the best time for intervention, since there is still no consensus in the literature on each of the options. 8 As we have seen, the controversies relating to management of patients with symptomatic or asymptomatic lesions of the bifurcation carotid are far from being resolved, despite almost 30 different sets of medical society guidelines aimed at organizing and standardizing conduct. Although there has been a perceptible movement over the last decade in the direction of reducing indications for intervention as a consequence of growing evidence of the efficacy of clinical treatment for asymptomatic stenosis, the legal and medical implications of not indicating carotid revascularization for a patient who fits the criteria for intervention according to current studies in the event that this patient has a stroke cannot be ignored.…”