TY - JOUR
T1 - Low Risk of Neurological Recurrence while Awaiting Carotid Endarterectomy
T2 - Results From a Danish Multicentre Study
AU - Lawaetz, Martin
AU - Sandholt, Benjamin
AU - Eilersen, Emilie N
AU - Petersen, Christian
AU - Tørslev, Katrine
AU - Shilenok, Dmitriy
AU - Houlind, Kim C
AU - Sillesen, Henrik
AU - Shahidi, Saeid
AU - Rathenborg, Lisbet K
AU - Eiberg, Jonas
N1 - Copyright © 2021 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.
PY - 2021/8
Y1 - 2021/8
N2 - OBJECTIVE: The risk of ipsilateral neurological recurrence (NR) was assessed in patients awaiting carotid endarterectomy (CEA) due to symptomatic carotid artery stenosis and whether current national guidelines of performing CEA within 14 days are adequate in present day practice.METHODS: This was a retrospective multicentre observational cohort study. Patients scheduled for CEA due to symptomatic carotid artery stenosis in a five year period, 1 January 2014 to 31 December 2018, from four centres were included. Data from the Danish Vascular Registry (www.karbase.dk), operative managing systems, and electronic medical records were reviewed.RESULTS: In total, 1 125 patients scheduled for CEA were included and 1 095 (97%) underwent the planned surgery. During a median delay from index event to CEA of 11 days (interquartile range 8-16 days), 40 patients (3.6%; 95% confidence interval [CI] 2.5%-5%) experienced a NR. One third were minor strokes (n = 12, 30%); half were transient ischaemic attacks (TIA) (n = 22, 55%); and amaurosis fugax accounted for 15% (n = 6). Twenty-six (2%) CEA procedures was cancelled, of which one was due to a disabling recurrent ischaemic event (aphasia). There were no deaths or major strokes in the waiting time for CEA. Best medical treatment (BMT) with platelet inhibitory or anticoagulation drugs and a statin was initiated in nearly all patients (98%) at first assessment. The overall 30 day risk of a post-operative major event (death or stroke) was (Kaplan-Meier [KM] estimate) 2.7% (95% CI 1.8-3.8), and not significantly correlated with the timing of surgery. Most (69%) occurred within the first three days. One, two, and three year mortality rate for CEA patients was (KM estimate) 4.8%, 7.8%, and 11.5% respectively.CONCLUSION: In symptomatic carotid artery stenosis patients awaiting CEA, very few NRs occurred within 14 days. Institution of immediate BMT in specialised TIA/stroke units followed by early, but not necessarily urgent, CEA is a reasonable course of action in patients with high grade symptomatic carotid artery stenosis.
AB - OBJECTIVE: The risk of ipsilateral neurological recurrence (NR) was assessed in patients awaiting carotid endarterectomy (CEA) due to symptomatic carotid artery stenosis and whether current national guidelines of performing CEA within 14 days are adequate in present day practice.METHODS: This was a retrospective multicentre observational cohort study. Patients scheduled for CEA due to symptomatic carotid artery stenosis in a five year period, 1 January 2014 to 31 December 2018, from four centres were included. Data from the Danish Vascular Registry (www.karbase.dk), operative managing systems, and electronic medical records were reviewed.RESULTS: In total, 1 125 patients scheduled for CEA were included and 1 095 (97%) underwent the planned surgery. During a median delay from index event to CEA of 11 days (interquartile range 8-16 days), 40 patients (3.6%; 95% confidence interval [CI] 2.5%-5%) experienced a NR. One third were minor strokes (n = 12, 30%); half were transient ischaemic attacks (TIA) (n = 22, 55%); and amaurosis fugax accounted for 15% (n = 6). Twenty-six (2%) CEA procedures was cancelled, of which one was due to a disabling recurrent ischaemic event (aphasia). There were no deaths or major strokes in the waiting time for CEA. Best medical treatment (BMT) with platelet inhibitory or anticoagulation drugs and a statin was initiated in nearly all patients (98%) at first assessment. The overall 30 day risk of a post-operative major event (death or stroke) was (Kaplan-Meier [KM] estimate) 2.7% (95% CI 1.8-3.8), and not significantly correlated with the timing of surgery. Most (69%) occurred within the first three days. One, two, and three year mortality rate for CEA patients was (KM estimate) 4.8%, 7.8%, and 11.5% respectively.CONCLUSION: In symptomatic carotid artery stenosis patients awaiting CEA, very few NRs occurred within 14 days. Institution of immediate BMT in specialised TIA/stroke units followed by early, but not necessarily urgent, CEA is a reasonable course of action in patients with high grade symptomatic carotid artery stenosis.
KW - Aged
KW - Aged, 80 and over
KW - Amaurosis Fugax/drug therapy
KW - Anticoagulants/therapeutic use
KW - Carotid Stenosis/complications
KW - Denmark
KW - Drug Therapy, Combination
KW - Endarterectomy, Carotid/mortality
KW - Female
KW - Humans
KW - Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use
KW - Ischemic Attack, Transient/etiology
KW - Ischemic Stroke/etiology
KW - Kaplan-Meier Estimate
KW - Male
KW - Middle Aged
KW - Platelet Aggregation Inhibitors/therapeutic use
KW - Postoperative Complications/etiology
KW - Recurrence
KW - Registries
KW - Retrospective Studies
KW - Risk Assessment
KW - Risk Factors
KW - Survival Rate
KW - Time-to-Treatment
UR - http://www.scopus.com/inward/record.url?scp=85107907222&partnerID=8YFLogxK
U2 - 10.1016/j.ejvs.2021.04.016
DO - 10.1016/j.ejvs.2021.04.016
M3 - Journal article
C2 - 34127375
VL - 62
SP - 160
EP - 166
JO - European Journal of Vascular Surgery
JF - European Journal of Vascular Surgery
SN - 1078-5884
IS - 2
ER -