Carotid Endarterectomy: A Single Institutional Experience of 28 Years From Pakistan

Khan, Mohammad Mussadiq; Khan, H.; Choudry, Usama Khalid; Kazmi, Tehreem; Amin, Amina; Azeem, Syed Muhammad

doi:10.1016/j.avsg.2020.12.059

Cited by 1 publication

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“…Ours is the largest Indian study and one among the largest single-center Asian series [27, 30] on the clinic-radiological profile of patients with symptomatic carotid stenosis who underwent CEA, looking at profile of the patients and the perioperative events. Our study highlights the need for public awareness on TIA and stroke and policies on early referral of patients for CEA.…”

Section: Discussionmentioning

confidence: 99%

Carotid Endarterectomy for Symptomatic Carotid Stenosis: Differences in Patient Profile in a Low-Middle-Income Country

Paramasivan

Sylaja

Pitchai

et al. 2022

Cerebrovasc Dis Extra

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Introduction: Carotid Endarterectomy (CEA) is the standard treatment for patients with symptomatic carotid stenosis. Data from Low- and Middle-Income Countries (LMIC) is sparse on CEA and its outcomes. We aimed to describe the profile of our patients, and factors associated with periprocedural cerebral ischemic events in patients with symptomatic carotid stenosis who underwent CEA in our institute. Methods: Retrospective review of patients with symptomatic carotid stenosis(50-99%) who underwent CEA between January 2011 and December 2021 was done. Clinical and imaging parameters and their influence on periprocedural cerebral ischemic events were analysed. Results: Of the 319 patients (77% males) with a mean age of 64 years (SD ±8.6), 207 (65%) presented only after a stroke. Majority (85%) had high grade stenosis (70%) of the symptomatic carotid. The mean time to CEA was 50 days (SD ±36), however only 26 patients (8.2%) underwent surgery within 2 weeks. Minor strokes and TIA occurred in 2.2%, while major strokes and death occurred in 4.1% patients. None of the clinical or imaging parameters predicted the periprocedural cerebral ischemic events. The presence of co-existing significant (50%) tandem intracranial atherosclerosis (n=77, 24%) or contralateral occlusion (n=24, 7.5%) did not influence the periprocedural stroke risk. Conclusion: There is a delay in patients undergoing CEA for symptomatic carotid stenosis. Majority have high grade stenosis and present late only after a stroke reflecting a lack of awareness. CEA can be performed safely even in patients with significant intracranial tandem stenosis and contralateral carotid occlusion.

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Section: Discussionmentioning

confidence: 99%