Early carotid endarterectomy in selected stroke patients

Although there are several reports suggesting the safety of performing caro tid endarterectomy (CE) within 4 weeks (early) of a nondisabling stroke, at many institutions it is not standard practice. Benefits of early surgery m ay include reduction in the number of strokes or carotid occlusions during the time between stroke and surgery, as well as a reduction in the cost of medical care due to the elimination of interval anticoagulation and close f ollow-up. This review examines the outcomes of early CE in selected patient s after a nondisabling stroke. A total of 1065 CEs were performed between N ovember 1991 and April 1998. Seventy-five patients were identified by compu terized hospital record and office chart review as having CE after a nondis abling stroke. Criteria for early surgery included 1) nondisabling stroke i psilateral to a carotid stenosis >50%, 2) neurological stability, and 3) no evidence of hemorrhagic stroke or significant cerebral edema by CT/MRI eva luation. This review suggests that early CE can be performed in selected pa tients with an acceptable perioperative morbidity and mortality.