Is early surgical revascularization of symptomatic carotid stenoses safe?
| Autor: | Thierry Merlini, Séverine Debiais, Bernard Enon, Sophie Godard, Guillaume Marc, Jean Picquet, Robert Martinez, Matthieu Péret, Pierre Lhommet |
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| Rok vydání: | 2013 |
| Předmět: |
Male
medicine.medical_specialty Time Factors medicine.medical_treatment Carotid endarterectomy Risk Assessment Time-to-Treatment Carotid stenoses Recurrence Risk Factors Medicine Humans Medical history Carotid Stenosis cardiovascular diseases Prospective Studies Hospitals Teaching Stroke Aged Aged 80 and over business.industry Mortality rate General Medicine Middle Aged medicine.disease Surgery Stenosis Treatment Outcome Ischemic Attack Transient Cohort Female France Cardiology and Cardiovascular Medicine business Vascular Surgical Procedures Surgical revascularization |
| Zdroj: | Annals of vascular surgery. 28(6) |
| ISSN: | 1615-5947 |
| Popis: | Background The objective of this exploratory study was to determine the rate of the complications of early surgery for symptomatic carotid stenosis, in 2 centers of Western France. Methods Between January 2011 and January 2013, we prospectively enrolled all the patients admitted for transient ischemic accident (TIA) or minor stroke (Rankin ≤ 3) associated with an ipsilateral carotid stenosis >50% (North American Symptomatic Carotid Endarterectomy Trial) and operated before the 14th day following the neurologic event at the University hospitals of Angers and Tours. The demographic data (gender, age, and medical history) and the characteristics of the procedures were recorded. The rates of stroke, TIA, and postoperative deaths defined the cumulative morbidity and mortality rate (CMMR) of the study. Results Ninety-one patients were included in the study. They presented 27 TIAs and 64 strokes. The average elapsed time between the neurologic event and surgery was 9.8 days. During this time, 10 patients, that is, 11% of the operated cohort, presented a new ischemic neurologic event while waiting for surgery. Surgical operations consisted of 56 eversions (61.5%), 32 endarterectomies with patch (35.1%), 2 bypasses, and 1 direct closure. The CMMR reached 3.3%. Two patients presented with a stroke and 1 patient died of a cardiologic cause during the postoperative period. Conclusions This study confirms the interest of an early surgery for symptomatic carotid stenoses with a Rankin score of ≤3. The risk of recurrence of a cerebral ischemic accident during the preoperative period remains high. |
| Databáze: | OpenAIRE |
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