Editor's Choice – Very Urgent Carotid Endarterectomy is Associated with an Increased Procedural Risk: The Carotid Alarm Study. (September 2017)

• Record Type: Journal Article
• Authors: Nordanstig, A.; Rosengren, L.; Strömberg, S.; Österberg, K.; Karlsson, L.; Bergström, G.; Fekete, Z.; Jood, K.
• Is Part Of: European journal of vascular and endovascular surgery. Volume 54:Number 3(2017)
• Page Start: 278
• Page End: 286
• Publication Date: 2017-09
• Subjects: Carotid endarterectomy -- Internal carotid artery -- Peri-operative outcome -- Stroke -- Symptomatic carotid stenosis; Blood-vessels -- Endoscopic surgery -- Periodicals; Blood-vessels -- Surgery -- Periodicals; Vascular Surgical Procedures -- Periodicals; Vascular Surgical Procedures -- methods -- Periodicals; Vaisseaux sanguins -- Chirurgie -- Périodiques; Vaisseaux sanguins -- Chirurgie endoscopique -- Périodiques; Blood-vessels -- Endoscopic surgery; Blood-vessels -- Surgery; Endoscopy; Electronic journals; Periodicals; Electronic journals; 617.413005
• DOI: 10.1016/j.ejvs.2017.06.017
• Languages: English
• ISSNs: 1078-5884

Abstract

Abstract : Objective/Background: The aim of the Carotid Alarm Study was to compare the procedural risk of carotid endarterectomy (CEA) performed within 48 hours with that after 48 hours to 14 days following an ipsilateral cerebrovascular ischaemic event. Methods: Consecutive patients with symptomatic carotid stenosis undergoing CEA were prospectively recruited. Time to surgery was calculated as time from the most recent ischaemic event preceding surgery. A neurologist examined patients before and, after CEA. The primary endpoint was the composite endpoint of death and/or any stroke within 30 days of the surgical procedure. The study was designed to include 600 patients, with 150 operated on within 48 hours. Results: From October 2010 to December 2015, 418 patients were included, of whom 75 were operated within 48 hours of an ischaemic event. The study was prematurely terminated owing to the slow recruitment rate in the group operated on within 48 hours. Patients undergoing CEA within 48 hours had a higher risk of reaching the primary endpoint than those operated on later (8.0% vs. 2.9%). Multivariate logistic regression analyses showed that CEA performed within 48 h (odds ratio [OR] 3.07; 95% confidence interval [CI] 1.04–9.09), CEA performed out of office hours (OR 3.65; 95% CI 1.14–11.67), and use of shunt (OR 4.02; 95% CI 1.36–11.93) were all independently associated with an increased risk of reaching the primary endpoint. Conclusion: CEA performed within 48 hours was associated with a higher risk of complications compared with surgery performed 48 hours–14 days after the most recent ischaemic event.