Early carotid endarterectomy in patients with a nondisabling ischemic stroke:: Results of a retrospective analysis

Background: There are several recent recommendations not to delay carotid endarterectomy (CEA)for at least 4 weeks in patients experiencing a nondisabling ischemic stroke. Therefore, were examined if these patients could be safely operated an earlier: The aim of our study was to review the perioperative stroke and death rates of CEA performed within 30 days of stroke onset. Patients and methods: During a 4 year period until December 2001, in 66 neurologically stable patients suffering a nondisabling stroke ipsilateral to a carotid artery stenosis > 50% CEA was performed after a median interval of 10 (1-28) days. The modified Rankin scale (mRS) was applied to characterize the severity of impairment of daily living activities pre- and postoperatively: Any postoperative deterioration > 24 hours on the mRS was considered as a new stroke. Results: Operative mortality was 0%, and postoperative neurologic worsening > 24 hours occurred in 8/66 patients (12, 1%). In 5/8 patients neurologic deterioration resolved within 5 days after surgery, only one stroke was permanent (1,5%). There was no correlation between timing of surgery or the presence of acute ipsilateral cranial CT defects with the occurrence of postoperative stroke. Stroke severity grading on admission according to the mRS, however, emerged to be a significant determinant of postoperative outcome: While 6/23 patients (26%) with an initial deficit greater than or equal to 3 on the mRS developed neurologic worsening, this was the case in only 6/23 patients (4,6%) with a deficit greater than or equal to 2 (Odds Ratio 7.2; 95% CI 1.32-39.49; two-sided p = 0.01). Conclusion: Our results suggest that selected patients with a minor stroke (mRS: 2 on admission) can safely undergo early CEA.