Abstract
Background: Recurrent ischemic events have been associated with delayed carotid endarterectomy (CEA) for patients who present with acute strokes. As such, earlier intervention has been advocated 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 after acute stroke. Methods: Our sample consisted of patients captured in the CEA-targeted American College of Surgeons National Surgical Quality Improvement Program data set between 2011 and 2015. The primary outcome was 30-day postoperative MACEs (death, stroke, or 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 acute strokes. Results: A total of 3,427 patients were identified who underwent CEA for acute stroke in the CEA-targeted files between 2011 and 2015. Overall, perioperative rates of 30-day death, stroke, or MI were 1.30% (n = 43), 2.74% (n = 94), and 0.96% (n = 33), respectively. There were no differences in 30-day postoperative death, stroke, or MI for early or delayed CEA after acute strokes. On multivariable analysis, independent predictors for postoperative MACEs in patients with acute stroke were age ≥80 years (OR 2.41; 95% CI [1.15–5.06]), preoperative beta-blocker use (OR 2.11; 95% CI [1.13–3.93]), and operative time > 150 min (OR 2.39; 95% CI [0.82–4.98]). Conclusions: There are no differences in postoperative 30-day death, stroke, or MI in early and delayed CEA after an acute stroke. These results substantiate the recommendation for early (<7 days) CEA after acute strokes.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 194-200 |
| Number of pages | 7 |
| Journal | Annals of vascular surgery |
| Volume | 57 |
| DOIs | |
| State | Published - May 2019 |
Funding
Funding: Research reported in this publication was supported by the National Heart, Lung and Blood Institute of the National Institutes of Health under award number T32HL094293 in the form of partial stipend support for Dr. Blay and Dr. Nooromid.Based on results of randomized clinical trials, professional society guidelines, and/or consensus statements, the anticipated risk of post-CEA death or stroke among symptomatic patients undergoing CEA is less than 6%, which supports the findings of our study.14 A recent analysis of early CEA in a prospectively maintained vascular registry showed that the rate of postoperative MI was 1.9% and 2.1% for CEA performed within 2 to 5 days and ≥6 days after admission, respectively.12 In this same study, the rate of stroke for CEA performed within 2 to 5 days and ≥6 days was 4% and 2.1%, respectively, whereas the rate of postoperative death was 1.9% and 1.1%, respectively. These results are consistent with the findings of our study and reinforce the recommendation of early CEA after an acute stroke after proper risk stratification. Although our results show that delayed CEA does not necessarily affect postoperative outcomes, early CEA could potentially lead to cost savings and avoidance of unintended postoperative, iatrogenic complications. Funding: Research reported in this publication was supported by the National Heart, Lung and Blood Institute of the National Institutes of Health under award number T32HL094293 in the form of partial stipend support for Dr. Blay and Dr. Nooromid.Based on results of randomized clinical trials, professional society guidelines, and/or consensus statements, the anticipated risk of post-CEA death or stroke among symptomatic patients undergoing CEA is less than 6%, which supports the findings of our study.14 A recent analysis of early CEA in a prospectively maintained vascular registry showed that the rate of postoperative MI was 1.9% and 2.1% for CEA performed within 2 to 5 days and ?6 days after admission, respectively.12 In this same study, the rate of stroke for CEA performed within 2 to 5 days and ?6 days was 4% and 2.1%, respectively, whereas the rate of postoperative death was 1.9% and 1.1%, respectively. These results are consistent with the findings of our study and reinforce the recommendation of early CEA after an acute stroke after proper risk stratification. Although our results show that delayed CEA does not necessarily affect postoperative outcomes, early CEA could potentially lead to cost savings and avoidance of unintended postoperative, iatrogenic complications. Funding: Research reported in this publication was supported by the National Heart, Lung and Blood Institute of the National Institutes of Health under award number T32HL094293 in the form of partial stipend support for Dr. Blay and Dr. Nooromid.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Surgery