Early is best for carotid surgery in symptomatic patients

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Dr Anthony J Comerota, University of Michigan, USA, reminded the ISET audience that, in order to prevent recurrent stroke, carotid endarterectomy should be performed no later than two weeks after a first transient ischaemic attack or nondisabling stroke. Comerota said that, despite a lack of evidence linking early endarterectomy with an increased risk of complications, surgeons remain fearful that early endarterectomy could lead to stroke or haemorrhage. However, “when we look at the literature, it does not appear in reports of early vs. late endarterectomy that there is an increase in morbidity from early surgery,” he said.

Comerota described a study (Sbargia E et al, Eur J Vasc Endovasc Surg 2006;32:22) that showed that among 96 patients with early endarterectomy after a stroke only 3.1% experienced worsening neurologic status while 9% had an unchanged status. Furthermore, 47% had “markedly improved” neurologic function, and there were no new infarcts on CT scan and no intracranial haemorrhages.
“A patient is at the highest risk of a stroke soon after the first ischaemic event,” Comerota said. “If most strokes are to be prevented, I will suggest that early procedure for symptomatic carotid stenosis is necessary since 69% of these strokes occur within four weeks of large vessel carotid artery disease becoming symptomatic.”

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