Timing of Carotid Endarterectomy After Stroke
Adam Tanious*1, Alexander B. Pothof*2, Laura Boitano*1, Alaska Pendleton*1, Linda J. Wang*1, Gert J. de Borst*3, David W. Rattner1, Marc L. Schermerhorn2, Mohammad H. Eslami*4, Mahmoud B. Malas*5, Matthew Eagleton*1, W. Darrin Clouse*1, Mark Conrad*1
1Massachusetts General Hospital, Boston, MA;2Beth Israel Deaconess Medical Center, Boston, MA;3University Medical Center, Utrecht, Netherlands4University of Pittsburgh, Pittsburgh, PA;5Johns Hopkins University, Baltimore, MD
Timing of carotid intervention in post-stroke patients is widely debated. Our objective was to identify the postoperative risk associated with different timing intervals of repair.
Utilizing Vascular Quality Initiative data, all carotid interventions performed on stroke patients between the years 2012-2017 were queried. Patients were then stratified based on the timing of surgery from their stroke (< 48hrs, 3-7 days, 8-14 days, > 15 days). Major outcomes included postoperative stroke, death, and MI.
A total of 8404 patients were included being predominantly male (5281, 62.8%), with an average age of 69 (+/- 10). Table 1 displays the outcome variables overall and broken down by timing groups with associated p-values. Patients treated at greater than 8 days showed significantly less risk of postoperative combined stroke/death as well as postoperative stroke. There were no significant differences in postoperative stroke or death between the 8-14 and greater than 15 days groups.
Multivariate regression analysis showed that delayed timing of surgery between 3-7 days was protective for postoperative stroke/death (p=.003) and any postoperative complication (p=.028). Delaying surgery to greater than 8 days after stroke was protective for postoperative stroke/death (p<.001), post-operative stroke (p<.001), and any postoperative complication (p<.001).
Carotid revascularization should occur no sooner than 48 hours after index stroke event. Surgeons should strive to operate between 8-14 days to protect against postoperative stroke/death.
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