@article{2997841,
    title = "Safety of urgent endarterectomy in acute non-disabling stroke patients with symptomatic carotid artery stenosis: an international multicenter study",
    author = "Roussopoulou, A. and Tsivgoulis, G. and Krogias, C. and Lazaris, A. and Moulakakis, K. and Georgiadis, G.S. and Mikulik, R. and Kakisis, J.D. and Zompola, C. and Faissner, S. and Chondrogianni, M. and Liantinioti, C. and Hummel, T. and Safouris, A. and Matsota, P. and Voumvourakis, K. and Lazarides, M. and Geroulakos, G. and Vasdekis, S.N.",
    journal = "European Journal of Paediatric Neurology",
    year = "2019",
    volume = "26",
    number = "4",
    pages = "673-679",
    publisher = "Wiley-Blackwell Publishing Ltd",
    issn = "1090-3798",
    doi = "10.1111/ene.13876",
    keywords = "aged;  angiography;  Article;  aspiration pneumonia;  atherosclerosis;  blood pressure;  brain hemorrhage;  brain ischemia;  carotid artery obstruction;  carotid artery surgery;  carotid endarterectomy;  cerebrovascular accident;  cranial nerve paralysis;  disease severity;  female;  follow up;  headache;  heart infarction;  hematoma;  human;  length of stay;  major clinical study;  male;  mortality rate;  multicenter study;  National Institutes of Health Stroke Scale;  outcome assessment;  priority journal;  prospective study;  Rankin scale;  stroke patient;  transient ischemic attack;  very elderly;  adverse event;  brain ischemia;  carotid artery obstruction;  carotid endarterectomy;  cerebrovascular accident;  clinical trial;  complication;  middle aged;  tertiary care center;  time factor;  treatment outcome, Aged;  Aged, 80 and over;  Brain Ischemia;  Carotid Stenosis;  Endarterectomy, Carotid;  Female;  Humans;  Male;  Middle Aged;  Stroke;  Tertiary Care Centers;  Time Factors;  Treatment Outcome",
    abstract = "Background and purpose: International recommendations advocate that carotid endarterectomy (CEA) should be performed within 2 weeks from the index event in symptomatic carotid artery stenosis (sCAS) patients. However, there are controversial data regarding the safety of CEA performed during the first 2 days of ictus. The aim of this international, multicenter study was to prospectively evaluate the safety of urgent (0–2 days) in comparison to early (3–14 days) CEA in patients with sCAS. Methods: Consecutive patients with non-disabling (modified Rankin Scale scores ≤2) acute ischaemic stroke or transient ischaemic attack due to sCAS (≥70%) underwent urgent or early CEA at five tertiary-care stroke centers during a 6-year period. The primary outcome events included stroke, myocardial infarction or death during the 30-day follow-up period. Results: A total of 311 patients with sCAS underwent urgent (n = 63) or early (n = 248) CEA. The two groups did not differ in baseline characteristics with the exception of crescendo transient ischaemic attacks (21% in urgent vs. 7% in early CEA; P = 0.001). The 30-day rates of stroke did not differ (P = 0.333) between patients with urgent (7.9%; 95% confidence interval 3.1%–17.7%) and early (4.4%; 95% confidence interval 2.4%–7.9%) CEA. The mortality and myocardial infarction rates were similar between the two groups. The median length of hospitalization was shorter in urgent CEA [6 days (interquartile range 4–6) vs. 10 days (interquartile range 7–14); P < 0.001]. Conclusions: Our findings highlight that urgent CEA performed within 2 days from the index event is related to a non-significant increase in the risk of peri-procedural stroke. The safety of urgent CEA requires further evaluation in larger datasets. © 2018 EAN"
}