Emergency carotid endarterectomy

Objective: Evaluation of the therapeutical efficacy of emergency carotid en darterectomy (CEA) in neurologically unstable patients. Patients and Method s: Three groups of a consecutive series of 71 emergency CEAs performed from 1980 to July 1998 were classified: (1) acute onset of severe stroke (n = 1 6), (2) progressive stroke/stroke in evolution (n = 34), and (3) crescendo transient ischemic attacks (n = 21). Cerebral coma, cerebral haemorrhage, a nd major ischemic stroke established in cranial computed tomography scans w ere contraindications for surgery. The neurological outcome was assessed by the modified Rankin scale. Long-term survival and long-term stroke recurre nces were analyzed. Results: The recovery/minor stroke rates (Rankin 0-3) i n acute stroke, progressive stroke, and crescendo transient ischemic attack s were 56.3, 76.4 and 80.9%, respectively; the combined major stroke/mortal ity rates (Rankin 4-6) were 43.7, 23.6 and 19.1%, respectively. Intraoperat ive angiography in 39 patients detected early carotid reocclusions in 2 and intracranial embolism in 7 patients. Local application of thrombolytic age nts (n = 5) may contribute to a better neurological outcome in emergency CE A. Life table probabilities of major stroke-free survival were 74.5, 71.6, and 53.7% after 1, 2, and 5 years, respectively (including perioperative st rokes). Life table probabilities to suffer no stroke recurrence during foll ow-up were 96.7, 96.7 and 85.3%, respectively (perioperative strokes exclud ed). Conclusions: Emergency CEA may be worthwhile in selected patients. Com pletion angiography is mandatory. Emergency CEA should be included in thera peutic strategies for ischemic stroke.