engleski

Urgent carotid endarterectomy

Background. Carotid endarterectomy (CEA) after acute stroke was generally delayed 6–8 weeks because of fear of stroke progression. Nowadays, a delay of surgery is proofed to be associated with a risk of recurrent cerebral ischemia. This delay can result with an interval stroke. Natural course of disease in patients with stroke in evolution lead to 80% mortality. Reliable data on the risk of carotid endarterectomy in relation to timing of surgery are necessary to plan CEA most effectively. Methods. We have analyzed studies available in literature concerning timing of CEA and its risks regarding combined perioperatively and long-term stroke and mortality rate and compared emergency and elective CEA. Results. Patients undergoing urgent CEA had higher perioperative mortality and stroke rate compared to elective CEA. When CEA is performed due to crescendo TIA within 6 hours and progressing neurological dysfunction and completed nonfluctuating deficits within 12 hours, the results almost always show improvement. Conclusions. Urgent CEA in patients with recent=crescendo TIA and stroke in evolution and fluctuating neurological deficit brings high operative risk, but those patients also may gain the most benefit from surgery. Careful patient selection and expeditious surgery give a potential for improvement in this limited but highly jeopardized group of patients.

Carotid endarterectomy

nije evidentirano