PILOT-STUDY OF CAROTID SURGERY FOR ACUTE STROKE

Background Carotid endarterectomy is usually delayed for 2 months foll owing an acute stroke, but the stroke may progress or a further stroke may occur. A randomized pilot study of urgent carotid surgery for acu te stroke was undertaken to assess the feasibility of a definitive mul ticentre trial. Methods Seven Manchester hospitals referred patients w ith acute stroke (less than 7 days previously), defined according to t he Oxfordshire Community Stroke Project classification. The carotid ar teries were examined by portable continuous-wave Doppler ultrasonograp hy. Patients with more than 50 per cent carotid stenosis on portable D oppler ultrasonography underwent colour duplex Doppler imaging. Patien ts with more than 70-99 per cent carotid stenosis were randomized to u rgent carotid surgery or best medical care. Results A total of 593 pat ients were assessed over 2 years. Of these, 414 had acute stroke, of w hom 380 had probable cerebral infarction. Complete ipsilateral interna l carotid artery occlusion was most common in patients with total ante rior circulation infarcts (33 (28 per cent) of 117), whereas severe ip silateral (70-99 per cent) stenosis was most common in partial anterio r circulation infarcts (25 (20 per cent) of 128). Only 16 patients (on e total and 15 partial anterior circulation infarcts) were fit enough for surgery and consented to randomization. Conclusion A definitive tr ial of urgent carotid surgery would need to screen large numbers of pa tients but could focus on patients with partial anterior circulation i nfarcts.