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Outcome of Carotid Endarterectomy for Acute Neurological Deficit

Division of Vascular and Endovascular Surgery, New York University School of Medicine, New York, firas.mussa{at}nyumc.org

Nicole Aaronson, BA

Division of Vascular and Endovascular Surgery, New York University School of Medicine, New York

Patrick J. Lamparello, MD

Division of Vascular and Endovascular Surgery, New York University School of Medicine, New York

Thomas S. Maldonado, MD

Division of Vascular and Endovascular Surgery, New York University School of Medicine, New York

Neal S. Cayne, MD

Division of Vascular and Endovascular Surgery, New York University School of Medicine, New York

Mark A. Adelman, MD

Division of Vascular and Endovascular Surgery, New York University School of Medicine, New York

Thomas S. Riles, MD

Division of Vascular and Endovascular Surgery, New York University School of Medicine, New York

Caron B. Rockman, MD

Division of Vascular and Endovascular Surgery, New York University School of Medicine, New York

We reviewed our experience with urgent carotid intervention in the setting of acute neurological deficits. Between June 1992 and August 2008, a total of 3145 carotid endarterectomies (CEA) were performed. Twenty-seven patients (<1.0%) were categorized as urgent. The mean age was 74.1 years (range 56-93 years) with 16 (60%) men, and 11 (40%) women, Symptoms included extremity weakness or paralysis (n = 13), amaurosis fugax (n = 6), speech difficulty (n = 2), and syncope, (n = 3). Three patients exhibited a combination of these symptoms. Three open thrombectomy were performed. Regional anesthesia was used in 13 patients (52%). Seventeen patients (67%), required shunt placement. At 30-days, 2 patient (7%) suffered a stroke, and 1 (4%) died. Urgent CEA can be performed safely. A stroke rate of 7% is acceptable in those who may otherwise suffer a dismal outcome without intervention.

Key Words: urgent carotid intervention • transient ischemic attacks • stroke in evolution • and nondisabling stroke

This version was published on August 1, 2009

Vascular and Endovascular Surgery, Vol. 43, No. 4, 364-369 (2009)
DOI: 10.1177/1538574409335276


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