Society For Clinical Vascular Surgery

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Early Carotid Endarterectomy After Acute Ischemic Stroke Yields Excellent Outcomes: An Analysis Of The Procedure-Targeted ACS-NSQIP
Eddie Blay, Jr., MD1, Yetunde Balogun, MD2, Michael J. Nooromid, MD1, Mark K. Eskandari, MD1.
1Northwestern University, Chicago, IL, USA, 2Temple University Hospital, Philadelphia, PA, USA.

OBJECTIVES: Recurrent ischemic events have been associated with delayed carotid endarterectomy (CEA) for patients who present with acute strokes or transient ischemic attacks (TIA). As such early intervention has been advocated in order to preserve cerebral function and expedient rehabilitation. We sought to determine the differences in 30-day postoperative major adverse clinical events (MACEs) for patients who undergo early (≤ 7 days) and delayed (>7 days) CEA for stroke vs TIA symptoms.
METHODS: Our sample consisted of patients captured in the CEA-targeted ACS NSQIP dataset between 2011 and 2015. The primary outcome was 30-day postoperative MACEs (death, stroke, and myocardial infarction (MI)). Differences in postoperative MACEs were determined between early and delayed CEA treatment. In addition, multivariable analyses were done to determine the association between various patient factors and postoperative complications after CEA for patients who presented with stroke vs TIA. RESULTS: A total of 6,302 patients were identified who underwent CEA for acute stroke or TIA in the CEA-targeted files between 2011 and 2015. There were no differences in 30-day postoperative mortality, stroke and MI for early or delayed CEA for either stroke or TIA. On multivariable analysis, independent predictors for postoperative MACEs in stroke patients were age ≥ 80 [OR 2.12; 95% CI (1.21-4.80)] and preoperative beta blocker use [OR 2.05; 95% CI (1.12-3.75)]. Independent predictors for postoperative MACEs for TIA patients were age ≥ 80 [OR 2.73; 95% CI (1.31-5.65)], American Society of Anesthesiologists Class 4 or 5 [OR 2.25; 95% CI (1.28-3.98)], 100% contralateral stenosis [OR 2.61; 95% CI (1.21-5.64)] and smoker [OR 2.07; 95% CI (1.07-4.01)]
CONCLUSIONS: There are no differences in postoperative 30-day mortality, stroke and MI in early and delayed CEA for both strokes and TIAs. These results reinforce the recommendation of early (< 7 days) CEA after acute ischemic stroke after proper risk stratification with special attention among patients of advanced age (> 80 years).

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