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Early carotid endarterectomy provides a better neurological outcome in symptomatic patients. A single center experience.

Research paper by Gianfranco G Varetto, Lorenzo L Gibello, Francesca F Sperti, Alessandra A Trevisan, Edoardo E Frola, Paolo P Garneri, Pietro P Rispoli

Indexed on: 27 May '17Published on: 27 May '17Published in: Annals of Vascular Surgery



Abstract

Many studies confirmed the role of early carotid endarterectomy to prevent recurrent stroke or transient ischemic attack however the mid-long term neurological benefit is still not completely investigated. The purpose of the study is to evaluate the role of early carotid endarterectomy on the peri and post-operative stroke/death complications of patients with a symptomatic carotid stenosis Material and methods: ninety consecutive patients were referred to our center for a symptomatic carotid stenosis. They were divided into two groups according to the time to surgery: G1 within 2 weeks (39 patients), G2 from 2 weeks to thereafter (51 patients). Neurological assessment was performed with the National Institutes of Health Stroke Scale (NIHSS) at presentation and at follow-up. Echo color-doppler Ultrasound was performed at 1-6 months and then yearly.The presentation of neurological symptoms differed significantly between the two groups, in fact minor stroke was more frequent in G1 while transient ischemic attack was more frequent in G2 (p-value 0,027). No significant differences emerged between the two groups on the surgical intervention or perioperative complications. The study showed a significant improvement of the neurological impairment (evaluated with a reduction of NIHSS score) of patients in G1 compared to G2 (p-value 0,01).Neurological recovery after a symptomatic carotid stenosis is strictly correlated to the variable "time to surgery". An higher sensitization of the general population on the early recognition of the symptoms and a strict collaboration with neurologists is mandatory to reduce time to CEA and improve clinical outcomes.