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Is the urgent carotid endarterectomy in patients with acute neurological symptoms a safe procedure?

^a Department of Cardiovascular Surgery, Hietzing Hospital, Wolkersbergenstr. 1, A-1130 Vienna, Austria
^b Department of Neurology, Hietzing Hospital, Vienna, Austria
^c Karl Landsteiner Institute for Cardiovascular Research, Hospital Hietzing, Vienna, Austria

*Corresponding author. Tel.: +43-1-80110; fax: +43-1-80110-2729.

E-mail address: michael.gorlitzer{at}wienkav.at (M. Gorlitzer).

The aim of the present case-control study was to assess patients with acute neurological symptoms requiring urgent carotid endarterectomy (CEA) and compare the outcome of the procedure in this group with that achieved in stable patients. Twenty-eight CEAs were performed in patients with an acute neurological deficit and 302 in stable patients from December 2006 to April 2008. Those selected for urgent surgery fulfilled the following criteria: acute onset of hemispheric neurological symptoms or crescendo TIAs, significant carotid pathology, the absence of cerebral hemorrhage, uncompromised vigilance, and stable cardiopulmonary conditions. Perioperative mortality in the stable patients' cohort was 0.33%. One patient died during the hospital stay because of myocardial infarction. Perioperative neurological events were observed in 2.2%: one ipsilateral stroke in stage II A, one contralateral stroke in stage I A, and a prolonged neurological deficit with complete restitution at the time of discharge in five patients. No mortality or neurological morbidity was encountered in those who underwent urgent CEA. Compared to stable patients with stage I, II or IV disease, neither mortality nor morbidity was increased in those who underwent urgent CEA. Urgent CEA after non-disabling stroke or crescendo TIAs is a safe procedure with a favorable outcome.

Key Words: Carotid endarterectomy; Crescendo TIA; Acute stroke