Rapid Access Carotid Endarterectomy can be Performed in the Hyperacute Period without a Significant Increase in Procedural Risks

Abstract

Objectives

The highest risk of recurrent stroke after suffering a transient ischaemic attack (TIA) or minor stroke is during the first 7–14 days. Contemporary guidelines recommend that carotid endarterectomy (CEA) should be performed within this time period, but there are concerns regarding (1) how this can be achieved logistically and (2) whether this policy is associated with a significant increase in procedural risks.

Design

This is a prospective, consecutive study of delays to surgery and 30-day outcomes in recently symptomatic patients who underwent CEA between 1 October 2008 and 15 June 2010 after the creation of a rapid access TIA service.

Results

A total of 109 symptomatic patients underwent CEA, 78% within 14 days of the index event and 90% within 14 days of referral. The median delay to surgery was 9 days from the index event and 4 days from referral. There were no perioperative deaths. Two strokes occurred (one intra-operative and one post-operative) to give a 30-day death/stroke rate of 1.83%. Patients undergoing CEA within 14 days of the index event incurred a death/stroke rate of 2.4% (2/84), increasing to 4.3% in patients undergoing surgery within 7 days (2/47).

Conclusion

Service reconfigurations can lead to significant reductions in delays to treatment in patients with symptomatic carotid disease. CEA can be performed in the hyperacute period without significantly increasing the operative risk.