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• W4241611894 abstract "Introduction - Symptomatic carotid artery stenosis needs prompt revascularization, preferentially within 2 weeks by endarterectomy (CEA) in order to reduce the risk of symptoms recurrence. However, the last ESVS-guidelines1 suggest delaying CEA in patients with large volume cerebral ischemic lesion (LVCIL) and modified Ranking Scale (mRS) >3, but the optimal timing of intervention is yet to be defined. Aim of the present study is to determine the most appropriate timing of CEA in patients with a recent stroke and LVCIL. Methods - Data from two tertiary hospitals for vascular treatment, serving a metropolitan area of 1 million people, were analyzed from 2007 to 2017. All patients submitted to CEA for an ischemic stroke were reviewed. Patients selected for the study had a clinical indication for CEA and an ischemic stroke with moderate disability (modified Ranking Scale [mRS] 3-4) and ipsilateral carotid stenosis >50%. The volume of cerebral ischemic lesion (CIL) was evaluated at the cerebral computed tomography after 48-72 hour from the stroke (calculated by the ellipsoid from the three major axis of the CIL), and only patients with LVCIL (>4000mm3)2 were considered in the analysis. CEA were performed in cases of stabilized neurological symptoms excluding patients with deteriorating neurological status after the stroke. Perioperative stroke/death were evaluated stratifying for timing of CEA by Chi-square and multiple logistic regression. Results - In an 11-year period, over a total 4020 CEAs, 126 (2.9%) were performed in patients with a moderate stroke and LVCIL. The patients mean age was 69±10 years, 72% (91) were male, with mRS=3±1 and LVCIL volume of 20000±47000mm3. The mean time elapsed from symptoms to CEA was 7±8 weeks. Overall perioperative stroke/death was 6.3% (8 stroke and 1 death). By selective timing evaluation of the post-operative events, CEA performed within 4-week were associated with a significant higher rate of stroke/death compared with patients operated after 4-weeks: 11.9% (8/67) vs 1.7% (1/59), P=.03. Patients submitted to CEA within and after 4-week from symptom had similar clinical and surgical characteristics. By logistic regression CEA within 4-weeks was an independent (from gender, CIL-volume, dyslipidemia and carotid stenosis) risk factor for postoperative stroke/death OR: 8.2, 95%CI 1.01-73. Conclusion - The surgical risk of CEA in patients with a recent moderate ischemic stroke and LVCIL is particularly high if the operation is performed within a 4 weeks period with significant reduction after that time. Despite its retrospective and observational nature this study suggests a careful evaluation of patients with LVCIL and a waiting time of at least 4 weeks. References1.Naylor AR, Ricco JB, de Borst GJ, Debus S, de Haro J, Halliday A, Hamilton G, Kakisis J, Kakkos S, Lepidi S, Markus HS, McCabe DJ, Roy J, Sillesen H, van den Berg JC, Vermassen F, Esvs Guidelines Committee, Kolh P, Chakfe N, Hinchliffe RJ, Koncar I, Lindholt JS, Vega de Ceniga M, Verzini F, Esvs Guideline Reviewers, Archie J, Bellmunt S, Chaudhuri A, Koelemay M, Lindahl AK, Padberg F, Venermo M. Editor's Choice - Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018 Jan;55(1):3-81.2.Pini R, Faggioli G, Longhi M, Ferrante L, Vacirca A, Gallitto E, Gargiulo M, Stella A. Impact of acute cerebral ischemic lesions and their volume on the revascularization outcome of symptomatic carotid stenosis. J Vasc Surg. 2017 Feb;65(2):390-397." @default.
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• W4241611894 date "2019-12-01" @default.
• W4241611894 modified "2023-09-27" @default.
• W4241611894 title "The Benefit of Deferred Carotid Revascularization in Patients with Moderate Disabling Cerebral Ischemic Stroke" @default.
• W4241611894 doi "https://doi.org/10.1016/j.ejvs.2019.06.880" @default.
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