Carotid endarterectomy at 3–14 days after ischemic stroke: results of a single-center registry

Background. According to Russian and European clinical guidelines, in patients who have experienced a primary acute cerebrovascular accident (CVA), and in the absence of contraindications, it is recommended to perform surgical treatment for symptomatic stenosis (50–99%) of the internal carotid artery as soon as possible — preferably within 3–14 days after the event. This is an important aspect of secondary prevention of a recurrent CVA (I, A). However, most Russian vascular surgeons have a negative attitude towards this clinical practice, recommending that carotid endarterectomy (CEA) be performed 3 months or more after the index event.

The aim of the study is to evaluate the effectiveness and safety of performing CEA on days 3–14 after an acute cerebrovascular event within the framework of the work of a regional vascular center.

Material and methods. The retrospective clinical study included 964 patients: the observation group consisted of 432 (45.1%) patients who underwent CEA between the 5th and 14th day inclusive after an acute cerebrovascular event; the control group consisted of 532 (54.9%) patients who were operated on between 15 and 180 days after the event. The primary endpoints included the composite endpoint of major adverse cardiovascular events (MACE): acute myocardial infarction, stroke, death from cardiovascular causes, and hemorrhagic transformation. Secondary endpoints: operational criteria, neurological assessment, and long‑term outcomes.

Results. No statistically significant differences were found for the combined primary endpoint – 14 (3.2%) and 11 (2.1%), p=0.266. The subanalysis revealed statistically significant differences according to the criterion of small cancer – 4 (0.9%) and 0, p=0.027. In the separated follow–up period, for up to 3 years, statistically significant differences were obtained between the groups according to the criterion of mortality from any cause + cancer – 5 (1.4%) out of 345 and 27 (5.8%) out of 460, p=0.004.

Conclusion. Performing CEA on days 1–14 after an acute ischemic stroke without contraindications is effective and safe, and is also justified in the long‑term period as an important aspect of primary prevention of recurrent ischemic stroke.

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