THE ROLE OF EARLY AND URGENT CEA IN PATIENTS WITH SYMPTOMATIC CAROTID ARTERY STENOSIS

Abstract

The selection of optimal timing for carotid surgery for symptomatic patients with carotid stenosis, remains a controversial issue. The latest guidelines advocate that carotid endarterectomy (CEA) should be performed within two weeks after index event (early CEA), in patients with symptomatic carotid stenosis ≥50% (according to NASCET criteria) or ≥70% (according to ESCT criteria) presenting with TIA (Transient Ischemic Attack) or minor acute ischemic stroke (AIS). However many patients do not undergo surgery during the recommended time-frame because a part of vascular surgeons is still reluctant to operate during the acute stroke stage, while substantial time delays in the referral of stroke patients from neurologists to vascular surgeons are occasionally documented. Possible benefit from carotid surgery is greatest when proceeding early. Therefore recent studies focus on identifying the ideal time period for CEA and also underline the importance of urgent CEA (performed within the first 48 hours of ictus) given the higher risk of recurrent cerebrovascular events during the first days following the index event in patients with symptomatic carotid artery stenosis. There are scarce and contradictory data regarding the safety of urgent CEA especially in neurologically unstable patients including crescendo TIA and AIS in evolution. The present study aims to critically review the available literature regarding the safety and efficacy of early and urgent CEA and describe the authors experience in this critical issue of selection of the appropriate time frame for carotid surgery in patients with symptomatic carotid artery stenosis in a comprehensive, tertiary care stroke center.