Efficacy and safety of urgent carotid endarterectomy in patients with acute ischemic stroke

Abstract

Introduction: Acute symptomatic occlusion of the internal carotid artery (ICA) is associated with unfavorable prognosis. However, no clear definition of its optimal treatment exists. The aim of this study was to evaluate the efficacy and risks of urgent carotid endarterectomy (CEA) in patients with ischemic stroke due to acute extracranial ICA occlusion.
Methods: A retrospective analysis was performed of all consecutive patients undergoing urgent CEA for acute extracranial ICA occlusion during the period from July 2014 to June 2021. The primary outcome was functional independence at three months defined as modified Rankin Scale (mRS) score ≤2. Secondary outcomes included the severity of the neurological deficit at the time of discharge and its comparison with the preoperative condition as assessed using the National Institutes of Health Stroke Scale (NIHSS), the incidence of symptomatic intracerebral hemorrhage (ICH), and 30-day periprocedural mortality.
Results: During the study period, a total of 42 urgent CEAs were performed for acute extracranial ICA occlusions. The median preoperative NIHSS score was 7 (interquartile range [IQR] 5–13). The median time interval between the onset of symptoms and surgery was 290 minutes (IQR 235–340). Technical success rate of urgent CEA was 97.6% (41 patients). The median NIHSS at the time of hospital discharge was 2 (IQR 3–7; p <0.001). An early clinical improvement by ≥2 points was achieved in 36 patients (85.7%). Symptomatic ICH occurred in one patient (2.4%) and one patient (2.4%) died. A good clinical outcome was achieved in 34 patients (81.0%) after three months.
Conclusion: This study demonstrated that patients with ischemic stroke due to acute extracranial ICA occlusion may benefit from urgent CEA.