The Timing of Carotid Endarterectomy


Authors: J. Mraček;  I. Holečková;  J. Mork;  M. Choc
Authors‘ workplace: Neurochirurgické oddělení LF UK a FN Plzeň
Published in: Cesk Slov Neurol N 2008; 71/104(4): 414-421
Category: Review Article

Overview

The timing of carotid endarterectomy (CEA) after a stroke remains a controversial area. Surgery is still, for the most part, delayed for 4 to 6 weeks post stroke due to the risk of postoperative intracerebral hemorrhage. More recently prospective studies and meta‑analyses of existing data have shown this arbitrary delay to be unnecessary. The combined risk of stroke recurrence and delayed surgery is higher than the risk of an early endarterectomy. The division of surgery into acute and delayed is inadequate. The ti­ming of CEA should have three levels: 1. emergent, 2. urgent and 3. delayed based on the strength of three essential criteria: a) clinical status, b) angiographic characteristics and c) CT or MRI findings. With regard to timing, the performing of a CEA is mostly for secondary prevention but may advance to become a treatment for the original cause of the problem in a selected group of patients with acute ictus or haemodynamic strokes. This article reviews the background of timing in carotid endarterectomy performed post stroke.

Key words:
carotid endarterectomy – timing – emergency – urgent – elective – stroke – transient ischemic attack – intracerebral hemorrhage


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