Carotid endarterectomy in patients with acute neurological symptoms

Aim. The aim of this study was to retrospectively evaluate our experience in urgent carotid endarterectomy (CEA) in patients with acute neurological symptoms comparing the results with those obtained in stable symptomatic patients in a case-control study. Methods. From January 1996 to December 2003, 2 564 consecutive CEAs were performed at our Department. In 55 cases CEA was carried out in patients with acute neurological deficit; in all these patients, clinical presentation were recent (<24 h) or crescendo (defined as 2 or more episodes in 24 h, with complete recovery after each episode) TIAs (group 1). Control group was randomly obtained from our historical database and consisted of 225 stable symptomatic patients operated on in the same period (group 2). Early (30 day) results in the 2 groups were compared by χ2 and Fisher exact tests; follow-up data were analysed by life-table analysis (Kaplan-Meier test) and results in subgroups were compared by means of log-rank test. Results. Considering mortality and any neurological morbidity, the patients of group 1 showed a cumulative rate of death and neurological complication significantly higher than those in group 2 (5.4% and 0.8%, respectively; P=0.005); however, when analyzing 30-day disabling strokes and deaths, the patients of group 1 had a cumulative complication rate of 1.8%, as in group 2 the corresponding figure was 0.4%. In patients of group 1 univariate analysis and logistic regression for multivariate analysis for 30-day risk of stroke and death did not show any influence of comorbidities, clinical status, anatomical and surgical features. Estimated cumulative 36 months-survival was significantly better in group 2 than in group 1. Considering the absence of ipsilateral stroke at 36 months, there were no differences between the 2 groups; however, analyzing the estimated absence of any neurological events, both ipsilateral and contralateral, at 36 months, patients of group 1 had a higher risk than those of group 2. Conclusion. Urgent CEA in patients with recent/crescendo TIA and appropriate carotid artery lesion carries good early and long term results, which however remain slightly poorer than those obtained in symptomatic patients with a stable neurological status.