The need for emergency surgical treatment in carotid-related stroke in evolution and crescendo transient ischemic attack
| Autor: | Laura Capoccia, Enrico Sbarigia, Danilo Toni, Antonella Biello, Francesco Speziale, Paolo Fiorani, Nunzio Montelione |
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| Rok vydání: | 2012 |
| Předmět: |
Male
medicine.medical_specialty Time Factors medicine.medical_treatment Rome Carotid endarterectomy Risk Assessment Severity of Illness Index Preoperative care Disability Evaluation Predictive Value of Tests Recurrence Risk Factors Preoperative Care medicine Humans Carotid Stenosis Prospective Studies cardiovascular diseases Prospective cohort study Stroke Aged Endarterectomy Aged 80 and over Endarterectomy Carotid Ultrasonography Doppler Duplex Chi-Square Distribution medicine.diagnostic_test business.industry Patient Selection Magnetic resonance imaging Recovery of Function Perioperative medicine.disease Magnetic Resonance Imaging Cerebral Angiography Surgery Stenosis Logistic Models Treatment Outcome Ischemic Attack Transient Female Tomography X-Ray Computed business Cardiology and Cardiovascular Medicine |
| Zdroj: | Journal of Vascular Surgery. 55(6):1611-1617 |
| ISSN: | 0741-5214 |
| DOI: | 10.1016/j.jvs.2011.11.144 |
| Popis: | ObjectiveThe purpose of this study was to examine the safety of emergency carotid endarterectomy (CEA) in patients with carotid stenosis and unstable neurological symptoms.MethodsThis prospective, single-center study involved patients with stroke in evolution (SIE) or fluctuating stroke or crescendo transient ischemic attack (cTIA) related to a carotid stenosis ≥50% who underwent emergency surgery. Preoperative workup included National Institute of Health Stroke Scale (NIHSS) neurological assessment on admission, immediately before surgery and at discharge, carotid duplex scan, brain contrast-enhanced head computed tomography (CT) or magnetic resonance imaging (MRI). End points were perioperative (30-day) neurological mortality, NIHSS score variation, and hemorrhagic or ischemic stroke recurrence. Patients were evaluated according to clinical presentation (SIE or cTIA), timing of surgery, and presence of brain infarction on neuroimaging.ResultsBetween January 2005 and December 2009, 48 patients were submitted to emergency surgery. CEAs were performed from 1 to 24 hours from onset of symptoms (mean, 10.16 ± 7.75). Twenty-six patients presented an SIE with a worsening NIHSS score between admission and surgery, and 22 presented ≥3 cTIAs with a normal NIHSS score (= 0) immediately before surgery. An ischemic brain lesion was detected in four patients with SIE and eight patients with cTIA. All patients with cTIA presented a persistent NIHSS normal score before and after surgery. Twenty-five patients with SIE presented an NIHSS score improvement after surgery. Mean NIHSS score was 5.30 ± 2.81 before surgery and 0.54 ± 0.77 at discharge in the SIE group (P < .0001). One patient with SIE had a hemorrhagic transformation of an undetected brain ischemic lesion after surgery, with progressive neurological deterioration and death (2%).ConclusionsDue to the absence of randomized controlled trials of CEA for neurologically unstable patients, data currently available do not support a policy of emergency CEA in those patients. Our results suggest that a fast protocol, including CT scans and carotid duplex ultrasound scans in neurologically unstable patients, could help identify those that can be safely submitted to emergency CEA. |
| Databáze: | OpenAIRE |
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