Safety of urgent endarterectomy in acute non-disabling stroke patients with symptomatic carotid artery stenosis

an international multicenter study

A. Roussopoulou, Georgios Tsivgoulis, C. Krogias, A. Lazaris, K. Moulakakis, G. S. Georgiadis, R. Mikulik, J. D. Kakisis, C. Zompola, S. Faissner, M. Chondrogianni, C. Liantinioti, T. Hummel, A. Safouris, P. Matsota, K. Voumvourakis, M. Lazarides, G. Geroulakos, S. N. Vasdekis

Research output: Contribution to journalArticle

Abstract

Background and purpose: International recommendations advocate that carotid endarterectomy (CEA) should be performed within 2 weeks from the index event in symptomatic carotid artery stenosis (sCAS) patients. However, there are controversial data regarding the safety of CEA performed during the first 2 days of ictus. The aim of this international, multicenter study was to prospectively evaluate the safety of urgent (0–2 days) in comparison to early (3–14 days) CEA in patients with sCAS. Methods: Consecutive patients with non-disabling (modified Rankin Scale scores ≤2) acute ischaemic stroke or transient ischaemic attack due to sCAS (≥70%) underwent urgent or early CEA at five tertiary-care stroke centers during a 6-year period. The primary outcome events included stroke, myocardial infarction or death during the 30-day follow-up period. Results: A total of 311 patients with sCAS underwent urgent (n = 63) or early (n = 248) CEA. The two groups did not differ in baseline characteristics with the exception of crescendo transient ischaemic attacks (21% in urgent vs. 7% in early CEA; P = 0.001). The 30-day rates of stroke did not differ (P = 0.333) between patients with urgent (7.9%; 95% confidence interval 3.1%–17.7%) and early (4.4%; 95% confidence interval 2.4%–7.9%) CEA. The mortality and myocardial infarction rates were similar between the two groups. The median length of hospitalization was shorter in urgent CEA [6 days (interquartile range 4–6) vs. 10 days (interquartile range 7–14); P < 0.001]. Conclusions: Our findings highlight that urgent CEA performed within 2 days from the index event is related to a non-significant increase in the risk of peri-procedural stroke. The safety of urgent CEA requires further evaluation in larger datasets.

Original languageEnglish (US)
Pages (from-to)673-679
Number of pages7
JournalEuropean Journal of Neurology
Volume26
Issue number4
DOIs
StatePublished - Apr 1 2019

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Endarterectomy
Carotid Endarterectomy
Carotid Stenosis
Multicenter Studies
Stroke
Safety
Transient Ischemic Attack
Myocardial Infarction
Confidence Intervals
Tertiary Care Centers
Hospitalization

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

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Safety of urgent endarterectomy in acute non-disabling stroke patients with symptomatic carotid artery stenosis : an international multicenter study. / Roussopoulou, A.; Tsivgoulis, Georgios; Krogias, C.; Lazaris, A.; Moulakakis, K.; Georgiadis, G. S.; Mikulik, R.; Kakisis, J. D.; Zompola, C.; Faissner, S.; Chondrogianni, M.; Liantinioti, C.; Hummel, T.; Safouris, A.; Matsota, P.; Voumvourakis, K.; Lazarides, M.; Geroulakos, G.; Vasdekis, S. N.

In: European Journal of Neurology, Vol. 26, No. 4, 01.04.2019, p. 673-679.

Research output: Contribution to journalArticle

Roussopoulou, A, Tsivgoulis, G, Krogias, C, Lazaris, A, Moulakakis, K, Georgiadis, GS, Mikulik, R, Kakisis, JD, Zompola, C, Faissner, S, Chondrogianni, M, Liantinioti, C, Hummel, T, Safouris, A, Matsota, P, Voumvourakis, K, Lazarides, M, Geroulakos, G & Vasdekis, SN 2019, 'Safety of urgent endarterectomy in acute non-disabling stroke patients with symptomatic carotid artery stenosis: an international multicenter study', European Journal of Neurology, vol. 26, no. 4, pp. 673-679. https://doi.org/10.1111/ene.13876
Roussopoulou, A. ; Tsivgoulis, Georgios ; Krogias, C. ; Lazaris, A. ; Moulakakis, K. ; Georgiadis, G. S. ; Mikulik, R. ; Kakisis, J. D. ; Zompola, C. ; Faissner, S. ; Chondrogianni, M. ; Liantinioti, C. ; Hummel, T. ; Safouris, A. ; Matsota, P. ; Voumvourakis, K. ; Lazarides, M. ; Geroulakos, G. ; Vasdekis, S. N. / Safety of urgent endarterectomy in acute non-disabling stroke patients with symptomatic carotid artery stenosis : an international multicenter study. In: European Journal of Neurology. 2019 ; Vol. 26, No. 4. pp. 673-679.
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abstract = "Background and purpose: International recommendations advocate that carotid endarterectomy (CEA) should be performed within 2 weeks from the index event in symptomatic carotid artery stenosis (sCAS) patients. However, there are controversial data regarding the safety of CEA performed during the first 2 days of ictus. The aim of this international, multicenter study was to prospectively evaluate the safety of urgent (0–2 days) in comparison to early (3–14 days) CEA in patients with sCAS. Methods: Consecutive patients with non-disabling (modified Rankin Scale scores ≤2) acute ischaemic stroke or transient ischaemic attack due to sCAS (≥70{\%}) underwent urgent or early CEA at five tertiary-care stroke centers during a 6-year period. The primary outcome events included stroke, myocardial infarction or death during the 30-day follow-up period. Results: A total of 311 patients with sCAS underwent urgent (n = 63) or early (n = 248) CEA. The two groups did not differ in baseline characteristics with the exception of crescendo transient ischaemic attacks (21{\%} in urgent vs. 7{\%} in early CEA; P = 0.001). The 30-day rates of stroke did not differ (P = 0.333) between patients with urgent (7.9{\%}; 95{\%} confidence interval 3.1{\%}–17.7{\%}) and early (4.4{\%}; 95{\%} confidence interval 2.4{\%}–7.9{\%}) CEA. The mortality and myocardial infarction rates were similar between the two groups. The median length of hospitalization was shorter in urgent CEA [6 days (interquartile range 4–6) vs. 10 days (interquartile range 7–14); P < 0.001]. Conclusions: Our findings highlight that urgent CEA performed within 2 days from the index event is related to a non-significant increase in the risk of peri-procedural stroke. The safety of urgent CEA requires further evaluation in larger datasets.",
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T1 - Safety of urgent endarterectomy in acute non-disabling stroke patients with symptomatic carotid artery stenosis

T2 - an international multicenter study

AU - Roussopoulou, A.

AU - Tsivgoulis, Georgios

AU - Krogias, C.

AU - Lazaris, A.

AU - Moulakakis, K.

AU - Georgiadis, G. S.

AU - Mikulik, R.

AU - Kakisis, J. D.

AU - Zompola, C.

AU - Faissner, S.

AU - Chondrogianni, M.

AU - Liantinioti, C.

AU - Hummel, T.

AU - Safouris, A.

AU - Matsota, P.

AU - Voumvourakis, K.

AU - Lazarides, M.

AU - Geroulakos, G.

AU - Vasdekis, S. N.

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Background and purpose: International recommendations advocate that carotid endarterectomy (CEA) should be performed within 2 weeks from the index event in symptomatic carotid artery stenosis (sCAS) patients. However, there are controversial data regarding the safety of CEA performed during the first 2 days of ictus. The aim of this international, multicenter study was to prospectively evaluate the safety of urgent (0–2 days) in comparison to early (3–14 days) CEA in patients with sCAS. Methods: Consecutive patients with non-disabling (modified Rankin Scale scores ≤2) acute ischaemic stroke or transient ischaemic attack due to sCAS (≥70%) underwent urgent or early CEA at five tertiary-care stroke centers during a 6-year period. The primary outcome events included stroke, myocardial infarction or death during the 30-day follow-up period. Results: A total of 311 patients with sCAS underwent urgent (n = 63) or early (n = 248) CEA. The two groups did not differ in baseline characteristics with the exception of crescendo transient ischaemic attacks (21% in urgent vs. 7% in early CEA; P = 0.001). The 30-day rates of stroke did not differ (P = 0.333) between patients with urgent (7.9%; 95% confidence interval 3.1%–17.7%) and early (4.4%; 95% confidence interval 2.4%–7.9%) CEA. The mortality and myocardial infarction rates were similar between the two groups. The median length of hospitalization was shorter in urgent CEA [6 days (interquartile range 4–6) vs. 10 days (interquartile range 7–14); P < 0.001]. Conclusions: Our findings highlight that urgent CEA performed within 2 days from the index event is related to a non-significant increase in the risk of peri-procedural stroke. The safety of urgent CEA requires further evaluation in larger datasets.

AB - Background and purpose: International recommendations advocate that carotid endarterectomy (CEA) should be performed within 2 weeks from the index event in symptomatic carotid artery stenosis (sCAS) patients. However, there are controversial data regarding the safety of CEA performed during the first 2 days of ictus. The aim of this international, multicenter study was to prospectively evaluate the safety of urgent (0–2 days) in comparison to early (3–14 days) CEA in patients with sCAS. Methods: Consecutive patients with non-disabling (modified Rankin Scale scores ≤2) acute ischaemic stroke or transient ischaemic attack due to sCAS (≥70%) underwent urgent or early CEA at five tertiary-care stroke centers during a 6-year period. The primary outcome events included stroke, myocardial infarction or death during the 30-day follow-up period. Results: A total of 311 patients with sCAS underwent urgent (n = 63) or early (n = 248) CEA. The two groups did not differ in baseline characteristics with the exception of crescendo transient ischaemic attacks (21% in urgent vs. 7% in early CEA; P = 0.001). The 30-day rates of stroke did not differ (P = 0.333) between patients with urgent (7.9%; 95% confidence interval 3.1%–17.7%) and early (4.4%; 95% confidence interval 2.4%–7.9%) CEA. The mortality and myocardial infarction rates were similar between the two groups. The median length of hospitalization was shorter in urgent CEA [6 days (interquartile range 4–6) vs. 10 days (interquartile range 7–14); P < 0.001]. Conclusions: Our findings highlight that urgent CEA performed within 2 days from the index event is related to a non-significant increase in the risk of peri-procedural stroke. The safety of urgent CEA requires further evaluation in larger datasets.

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