Multicenter study: carotid endarterectomy in the first hours after ischemic stroke

Abstract

Aim. To analyze inhospital outcomes of carotid endarterectomy (CE) in the acute period (within 3 days from the onset) of ischemic stroke.Material and methods. This retrospective multicenter study for the period from January 2008 to August 2020 included 357 patients who underwent CE in the acute period of stroke. An interdisciplinary commission defined the revascularization timing. There were following inclusion criteria: 1. Mild neurological disorders: NIHSS stroke of 3-8; modified Rankin Scale score <2; Bartel index >61; 2. Indications for CE according to the current national guidelines; 3. Brain ischemic focus <2,5 cm in diameter. There were following exclusion criteria: 1. Presence of contraindications to CE. The endpoints were such unfavorable cardiovascular events as death, myocardial infarction (MI), stroke/transient ischemic attack (TIA), silent stroke, silent hemorrhagic transformations, Bleeding Academic Research Consortium (BARC) type >3b bleeding, internal carotid artery thrombosis, composite endpoint (death + all strokes/TIA + MI). Silent strokes were those strokes, established according to control multi-slice computed tomography angiography, without symptoms.Results. During the in-hospital follow-up period, 8 deaths (2,24%), 5 MIs (1,4%), 6 strokes/TIAs (1,7%), 15 silent ischemic strokes (4,2%), 13 hemorrhagic transformations (3,6%), 26 silent hemorrhagic transformations (7,3%), and 6 BARC type >3b bleeding (1,7%) were recorded. Thus, the combined endpoint was 20,4% (n=73).Conclusion. Due to the high incidence of cardiovascular events, CE is not a safe operation for patients in the acute period of ischemic stroke. The stroke + mortality rate exceeding 3% demonstrates the ineffectiveness of this method of treatment.

Long-term outcomes of eversion and conventional carotid endarterectomy: A multicenter clinical trial

“…Albeit current guidelines do not specify the benefits of either ECEA or virtually assisted CCEA [18] , we suggest that cerebral revascularization should become increasingly personalised. Systemic risk factors for the development of restenosis affect CEA outcomes regardless of intervention type [32][33][34][35][36] . Most of them are modifiable, yet it has been shown that genetic background also affects the long-term outcomes [37][38][39][40][41] .…”

Long-term outcomes of combined coronary bypass surgery and carotid endarterectomy in patients with type 2 diabetes

“…При анализе отдаленных результатов КЭЭ у больных с СД 2 авторы приводят данные, доказывающие, что в этой когорте пациентов больше частота развития рестеноза ВСА, ОНМК, ИМ, летального исхода [31][32][33]. Настоящие процессы, безусловно, являются мультитаргетными и включают в себя наследственность, образ жизни, последствия метаболического синдрома [34,35].…”

Vertebral triangle of doctor A.N. Kazantsev - double vertebral artery in V3 segment

“…In the presence of hemodynamically significant stenosis of the internal carotid artery (ICA), some studies come to conclusions about the safety and efficacy of both carotid endarterectomy and carotid angioplasty with stenting in the acute period (days 1-3) stroke [6] , [7] , [8] , [9] , [10] . Other authors, referring to the high risk of developing hemorrhagic transformation, in some cases call for postponing emergency brain revascularization until the acute (days 4-28) or early recovery (days 29-6 months) stroke periods [11] , [12] , [13] , [14] , [15] .…”