August 7, 2009Stroke184 citationsOpen Access
View Full PaperSystematic Review of the Operative Risks of Carotid Endarterectomy for Recently Symptomatic Stenosis in Relation to the Timing of Surgery
Structured PICO
Does early or emergency carotid endarterectomy increase operative risk compared to delayed surgery in patients with recently symptomatic carotid stenosis?
P
Population
Patients with recently symptomatic carotid stenosis, including those with stroke-in-evolution, crescendo TIA, minor stroke, or major nondisabling stroke
I
Intervention
Early or emergency carotid endarterectomy (e.g., surgery in the first week)
C
Comparator
Delayed surgery
O
Outcome
Operative risksafety
Early carotid endarterectomy within the first week for neurologically stable patients with TIA or minor stroke does not carry a substantially higher operative risk than delayed surgery, supporting early intervention in this cohort.
Abstract
Emergency endarterectomy for stroke-in-evolution has a high operative risk, but the risk may be somewhat lower in patients with crescendo TIA. Surgery in the first week in neurologically stable patients with TIA or minor stroke is not associated with a substantially higher operative risk than delayed surgery. More data are required on the risk and benefit of more urgent surgery for TIA and minor stroke and for early versus delayed surgery in patients with major nondisabling stroke.
Cite This Study
Rerkasem et al. (Fri,) studied this question.