Safety and Efficacy of Early Carotid Endarterectomy in Patients with Symptomatic Carotid Artery Stenosis: A Meta-Analysis

Overview

Journal Biomed Res Int

Publisher Wiley

Specialties Biomedical Engineering
Biotechnology
General Medicine

Date 2021 Jan 28

PMID 33506024

Citations 1

Authors

Xiao Chen

Jing Su

Guojun Wang

Han Zhao

Shizhong Zhang

Tao Liu

Xindi Su

Ning Zhou

Affiliations

Soon will be listed here.

Abstract

Design: A systematic document retrieval of studies published in the past 10 years reporting periprocedural stroke/mortality/MI after carotid endarterectomy (CEA) related to the time between CEA and qualifying neurological symptoms. The application database has "PubMed, EMbase and Cochrane databases." RevMan5.3 software provided by the Cochrane collaboration was used for meta-analysis.

Results: A systematic literature search was conducted in databases. A total of 10 articles were included in this study. They were divided into early CEA and delayed CEA with operation within 48 h, 1 w, or 2 w after onset of neurological symptoms. Incidence of the postoperative stroke in patients undergoing delayed CEA (≥48 h) was significantly higher than patients with delayed CEA (<48 h) (OR = 2.14, 95% CI: 1.43-3.21, = 0.0002). The postoperative mortality of patients after delayed CEA (≥48 h) was significantly higher than patients after early CEA (<48 h) (OR = 1.35, 95% CI: 1.06-1.71, = 0.02). The risk of postoperative mortality of patients treated with delayed CEA (≥7 d) was significantly higher than patients after the early CEA group (<7 d) (OR = 1.69, 95% CI: 1.21-2.32, = 0.001).

Conclusion: Early CEA is safe and effective for a part of patients with symptomatic carotid stenosis, but a comprehensive preoperative evaluation of patients with carotid stenosis must be performed.

Citing Articles

Retracted: Safety and Efficacy of Early Carotid Endarterectomy in Patients with Symptomatic Carotid Artery Stenosis: A Meta-Analysis.

International B Biomed Res Int. 2024; 2024:9797043.

PMID: 38550221 PMC: 10977312. DOI: 10.1155/2024/9797043.

References

Keldahl M, Eskandari M . Timing of carotid surgery after acute stroke. Expert Rev Cardiovasc Ther. 2010; 8(10):1399-403. DOI: 10.1586/erc.10.122. View

Capoccia L, Sbarigia E, Speziale F, Toni D, Fiorani P . Urgent carotid endarterectomy to prevent recurrence and improve neurologic outcome in mild-to-moderate acute neurologic events. J Vasc Surg. 2010; 53(3):622-7. DOI: 10.1016/j.jvs.2010.09.016. View

Ferrero E, Ferri M, Viazzo A, Gaggiano A, Ferrero M, Maggio D . Early carotid surgery in patients after acute ischemic stroke: is it safe? A retrospective analysis in a single center between early and delayed/deferred carotid surgery on 285 patients. Ann Vasc Surg. 2010; 24(7):890-9. DOI: 10.1016/j.avsg.2010.03.014. View

Rockman C, Maldonado T, Jacobowitz G, Cayne N, Gagne P, Riles T . Early carotid endarterectomy in symptomatic patients is associated with poorer perioperative outcomes. J Vasc Surg. 2006; 44(3):480-7. DOI: 10.1016/j.jvs.2006.05.022. View

Naylor A . Delay may reduce procedural risk, but at what price to the patient?. Eur J Vasc Endovasc Surg. 2008; 35(4):383-91. DOI: 10.1016/j.ejvs.2008.01.002. View

Annambhotla S, Park M, Keldahl M, Morasch M, Rodriguez H, Pearce W . Early versus delayed carotid endarterectomy in symptomatic patients. J Vasc Surg. 2012; 56(5):1296-302. PMC: 3478477. DOI: 10.1016/j.jvs.2012.05.070. View

Jivegard L, Gelin J, Stromberg S, Osterberg K . Comment regarding "Rapid access carotid endarterectomy can be performed in the hyperacute period without a significant increase in procedural risks" by M.K. Salem, R.D. Sayers, M.J. Brown, D.J. Eveson, T.G. Robinson and A.R. Naylor. Eur J Vasc Endovasc Surg. 2011; 42(3):403. DOI: 10.1016/j.ejvs.2011.04.036. View

Rantner B, Schmidauer C, Knoflach M, Fraedrich G . Very urgent carotid endarterectomy does not increase the procedural risk. Eur J Vasc Endovasc Surg. 2014; 49(2):129-36. DOI: 10.1016/j.ejvs.2014.09.006. View

Liu H, Chu J, Zhang L, Liu C, Yan Z, Zhou S . Clinical Comparison of Outcomes of Early versus Delayed Carotid Artery Stenting for Symptomatic Cerebral Watershed Infarction due to Stenosis of the Proximal Internal Carotid Artery. Biomed Res Int. 2016; 2016:6241546. PMC: 5149605. DOI: 10.1155/2016/6241546. View

10.

Sharpe R, Sayers R, London N, Bown M, McCarthy M, Nasim A . Procedural risk following carotid endarterectomy in the hyperacute period after onset of symptoms. Eur J Vasc Endovasc Surg. 2013; 46(5):519-24. DOI: 10.1016/j.ejvs.2013.08.014. View

11.

Dorigo W, Pulli R, Nesi M, Alessi Innocenti A, Pratesi G, Inzitari D . Urgent carotid endarterectomy in patients with recent/crescendo transient ischaemic attacks or acute stroke. Eur J Vasc Endovasc Surg. 2011; 41(3):351-7. DOI: 10.1016/j.ejvs.2010.11.026. View

12.

Kjorstad K, Baksaas S, Bundgaard D, Halbakken E, Hasselgard T, Jonung T . Editor's Choice - The National Norwegian Carotid Study: Time from Symptom Onset to Surgery is too Long, Resulting in Additional Neurological Events. Eur J Vasc Endovasc Surg. 2017; 54(4):415-422. DOI: 10.1016/j.ejvs.2017.07.013. View

13.

Paraskevas K, Loftus I . Safety of carotid revascularization within 48 hours of symptomatic presentation. J Cardiovasc Surg (Torino). 2016; 58(2):139-142. DOI: 10.23736/S0021-9509.16.09743-3. View

14.

Villwock M, Singla A, Padalino D, Ramaswamy R, Deshaies E . Optimum timing of revascularization for emergent admissions of carotid artery stenosis with infarction. Clin Neurol Neurosurg. 2014; 127:128-33. DOI: 10.1016/j.clineuro.2014.10.008. View

15.

Barnett H, Taylor D, Eliasziw M, Fox A, Ferguson G, Haynes R . Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 1998; 339(20):1415-25. DOI: 10.1056/NEJM199811123392002. View

16.

Ballotta E, Da Giau G, Baracchini C, Abbruzzese E, Saladini M, Meneghetti G . Early versus delayed carotid endarterectomy after a nondisabling ischemic stroke: a prospective randomized study. Surgery. 2002; 131(3):287-93. DOI: 10.1067/msy.2002.119987. View

17.

Costa E Silva A, Da Cruz Junior A, do Nascimento N, Candeira S, Almeida A, de Castro K . Positive Balance Recovery in Ischemic Post-Stroke Patients with Delayed Access to Physical Therapy. Biomed Res Int. 2020; 2020:9153174. PMC: 7003254. DOI: 10.1155/2020/9153174. View

18.

Stromberg S, Gelin J, Osterberg T, Bergstrom G, Karlstrom L, Osterberg K . Very urgent carotid endarterectomy confers increased procedural risk. Stroke. 2012; 43(5):1331-5. DOI: 10.1161/STROKEAHA.111.639344. View

19.

Tsantilas P, Kuhnl A, Kallmayer M, Pelisek J, Poppert H, Schmid S . A short time interval between the neurologic index event and carotid endarterectomy is not a risk factor for carotid surgery. J Vasc Surg. 2016; 65(1):12-20.e1. DOI: 10.1016/j.jvs.2016.07.116. View

20.

Saver J . Time is brain--quantified. Stroke. 2005; 37(1):263-6. DOI: 10.1161/01.STR.0000196957.55928.ab. View