Timing of carotid surgery after acute stroke

Abstract

Carotid endarterectomy (CEA) has been proven to reduce the risk of stroke and death in both asymptomatic and symptomatic patients with carotid occlusive disease. Stroke is the third leading cause of death in the USA. Since up to one-third of stroke patients have a stroke secondary to carotid occlusive disease, it is important to offer CEA to this subgroup of patients that meet indications for surgery. Historically, literature has suggested that the optimal timing to perform CEA is approximately 6 weeks after an acute stroke. This was concluded owing to high perioperative morbidity and mortality if CEA was performed too early. However, data are increasingly showing that some patients do benefit from CEA earlier than 6 weeks after an acute stroke. This article discusses mid-20th Century literature and focuses on more recent 21st Century literature discussing the timing of CEA after acute stroke. Although there are data to support delayed CEA, it is reasonable to perform early CEA in select stroke patient populations. Candidates for early CEA should have complete or near resolution of symptoms, small infarcts on imaging and ipsilateral carotid stenosis.

Keywords::

• carotid endarterectomy
• carotid occlusive disease complications
• stroke
• timing

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Notes

TIA: Transient ischemic attack.

Data taken from [26].