Key result
Urgent carotid endarterectomy for crescendo TIA linked to ~8-fold higher mortality versus elective surgery.
Why the study?
The timing of carotid endarterectomy, especially in cases of acute neurological symptoms like crescendo transient ischemic attack and stroke-in-evolution, remains contentious.
Does urgent carotid endarterectomy within 6 hours improve outcomes compared to elective carotid endarterectomy within 2 weeks in patients with crescendo TIA?
Population
87 patients with crescendo TIA and 174 matched controls with symptomatic carotid disease
Comparison
Urgent CEA within 6 hours of crescendo TIA onset vs elective CEA within 2 weeks
Design
Retrospective matched cohort study
Follow-up
Up to 6 months
Authors
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Should not prompt shift to urgent CEA within 6 hours; leaves open optimal timing for crescendo TIA endarterectomy.
Cohort (n=261)
Does urgent carotid endarterectomy within 6 hours improve outcomes compared to elective carotid endarterectomy within 2 weeks in patients with crescendo TIA?
Absolute Event Rate: 4.6% vs 0.6%
p-value: p=0.044
Urgent carotid endarterectomy within 6 hours for crescendo TIA prevents recurrent strokes similarly to elective procedures but is associated with higher mortality driven by myocardial infarction.
Gajin et al. (2025) conducted a cohort in Crescendo transient ischemic attack (n=261). Urgent carotid endarterectomy (UCEA) within 6 hours vs. Elective carotid endarterectomy (ECEA) within 2 weeks was evaluated on Overall mortality (p=0.044). Urgent carotid endarterectomy within 6 hours of crescendo TIA was associated with higher overall mortality compared to elective endarterectomy (4.6% vs. 0.6%; p=0.044).
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