Results of Early Endarterectomies after Transient Ischaemic Attack


Authors: M. Orlický 1,2;  P. Vachata 1,2;  M. Sameš 1
Authors‘ workplace: Neurochirurgická klinika Masarykovy nemocnice a Univerzity J. E. Purkyně, Ústí nad Labem 1;  ICRC – Mezinárodní centrum klinického výzkumu, FN u sv. Anny v Brně 2
Published in: Cesk Slov Neurol N 2015; 78/111(5): 550-554
Category: Original Paper
doi: https://doi.org/10.14735/amcsnn2015550

Overview

Aim:
The importance of early endarterectomy (CEA) for secondary stroke prevention in patients after transient ischaemic attack (TIA) inspired an analysis of our data and their correlation with generally accepted recommendations to ascertain whether any improvements are needed.

Material and methods:
975 CEA were performed within a prospective study from 2006 to 2013 at the Clinic of Neurosurgery, Masaryk Hospital in Usti nad Labem. All procedures were done under regional anaesthesia. Magnetic resonance of the brain in diffusion-weighted mode was performed within 24 hours before and after the surgical procedure. 187 procedures in patients with symptomatic TIAs were analysed in detail. We focused on: 1. period (in days) from the onset of symptoms until carotid endarterectomy itself; 2. number and type of perioperative complications in relation to operation timing.

Results:
1. Since 2007, the mean symptom-to-surgery period in the all TIAs group was acceptable: 3.5–14 days. The mean values in the hemispheral TIAs group were even lower: 3–13 days. The mean symptom-to-surgery period exceeded the recommended values in the group of TIAs with amaurosis fugax (AF) only: 14–25.5 days. 2. Perioperative and early postoperative complications rate was 2.5% and was not higher in early surgeries.

Conclusion:
CEA management of post-hemispheral TIA patients by the Comprehensive Cerebrovascular Centre in Usti nad Labem in cooperation with other stroke units in Ustecky region, was in line with available recommendations with respect to timing as well as complication rate. Public should be better educated on AF in order to decrease symptom-to-surgery period for CEA in post-TIA patients.

Key words:
carotid endarterectomy timing – symptom­atic stenosis – transient ischaemic attacks

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.


Sources

1. North American Symp­tomatic Carotid Endarterectomy Trial. Methods, patient characteristics, and progres­s.Stroke 1991; 22(6): 711– 720.

2. North American Symp­tomatic Carotid Endarterectomy Trial Col­laborators. Beneficial ef­fect of carotid endarterectomy in symp­tomatic patients with high‑grade carotid stenosis. N Engl J Med 1991; 325(7): 445– 453.

3. Barnett HJ, Taylor DW, Eliasziw M, Fox AJ, Ferguson GG, Haynes RB et al. Benefit of carotid endarterectomy in patients with symp­tomatic moderate or severe stenosis. North American Symp­tomatic Carotid Endarterectomy Trial Col­laborators. N Engl J Med 1998; 339(20): 1415– 1425.

4. Adams RJ, Albers G, Alberts MJ, Benavente O, Furie K,Goldstein LB et al. Update to the AHA/ ASA recom­mendations for the prevention of stroke in patients with stroke and transient ischemic attack. Stroke 2008; 39(5): 1647– 1652. doi: 10.1161/ STROKEAHA.107.189063.

5. DeWeese JA, Rob CG, Satran R, Marsh DO, Joynt RJ, Sum­mers D et al. Results of carotid endarterectomies for transient ischemic attacks –  five years later. An­n Surg 1973; 178(3): 258– 264.

6. Giordano JM, Trout HH, Kozlof­f L, DePalma RG. Tim­ing of carotid artery endarterectomy after stroke. J Vasc Surg 1985; 2(2): 250– 255.

7. Wylie EJ, Hein MF, Adams JE. Intracranial hemor­rhage fol­low­ing surgical revascularization for treatment of acute strokes. J Neurosurg 1964; 21: 212– 215.

8. Randomised trial of endarterectomy for recently symp­tomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet 1998; 351(9113): 1379– 1387.

9. Gasecki AP, Ferguson GG, Eliasziw M, Clagett GP, Fox AJ,Hachinski V et al. Early endarterectomy for severe carotid artery stenosis after a nondisabl­ing stroke: results from the North American Symp­tomatic Carotid Endarterectomy Trial. J Vasc Surg 1994; 20(2): 288– 295.

10. Bal­lotta E, Da Giau G, Baracchini C, Abbruzzese E, Saladini M, Meneghetti G. Early versus delayed carotid endarterectomy after a nondisabl­ing ischemic stroke: a prospective randomized study. Surgery 2002; 131(3): 287– 293.

11. Rothwel­l PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJ. Endarterectomy for symp­tomatic carotid stenosis in relation to clinical subgroups and tim­ing of surgery. Lancet 2004; 363(9413): 915– 924.

12. Gasecki AP, Eliasziw M. Tim­ing of carotid endarterectomy after stroke. Stroke 1998; 29(12): 2667– 2668.

13. Rothwel­l PM, Warlow CP. Tim­ing of TIAs preced­ing stroke: time window for prevention is very short. Neurology 2005; 64(5): 817– 820.

14. Rothwel­l PM, Buchan A, Johnston SC. Recent advances in management of transient ischaemic attacks and minor ischaemic strokes. Lancet Neurol 2006; 5(4): 323– 331.

15. Rothwel­l PM, Goldstein LB. Carotid endarterectomy for asymp­tomatic carotid stenosis asymp­tomatic carotid surgery trial. Stroke 2004; 35(10): 2425– 2427.

16. Easton JD, Saver JL, Albers GW, Alberts MJ, Chaturvedi S, Feldman­n E et al. Definition and evaluation of transient ischemic attack: a scientific statement for healthcare profes­sionals from the American Heart As­sociation/ American Stroke As­sociation Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology af­firms the value of this statement as an educational tool for neurologists. Stroke 2009; 40(6): 2276– 2293. doi: 10.1161/ STROKEAHA.108.192218.

17. Szabo K, Kern R, Gas­s A, Hirsch J, Hen­nerici M. Acute stroke patterns in patients with internal carotid artery dis­ease: a dif­fusion‑ weighted magnetic resonance imag­ing study. Stroke 2001; 32(6): 1323– 1329.

18. Orlický M, Vachata P, Bartoš R, Sameš M. Skrat u karotických endarterektomií zvyšuje riziko ischemického iktu. Cesk Slov Neurol N 2015; 78/ 111(2): 163– 166. doi: 10.14735/ amcsn­n2015163.

19. Little JR, Moufar­rij NA, Furlan AJ. Early carotid endarterectomy after cerebral infarction. Neurosurgery 1989; 24(3): 334– 338.

20. Bruetman ME, Fields WS, Crawford ES, Debakey ME. Cerebral hemor­rhage in carotid artery surgery. Arch Neurol 1963; 9: 458– 467.

21. Bond R, Rerkasem K, Rothwel­l PM. Systematic review of the risks of carotid endarterectomy in relation to the clinical indication for and tim­ing of surgery. Stroke 2003; 34(9): 2290– 2301.

22. Mraček J, Holečková I, Mork J. Tim­ing karotické endarterektomie. Cesk Slov Neurol N 2008; 71/ 104(4): 414– 421.

23. Benavente O, Eliasziw M, Streifler JY, Fox AJ, Barnett HJ,Meldrum H et al. Prognosis after transient monocular blindnes­s as­sociated with carotid‑ artery stenosis. N Engl J Med 2001; 345(15): 1084– 1090.

24. Vachata P, Orlický M, Sameš M. Clopidogrel a karotická endarterektomie. Praha: Kuncův memoriál 2013.

Labels
Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 5

2015 Issue 5

Most read in this issue
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account