Systematic review of the operative risks of carotid endarterectomy for recently symptomatic stenosis in relation to the timing of surgery

Background and Purpose-: Reliable data on the risk of carotid endarterectomy (CEA) in relation to timing of surgery are necessary to plan CEA most effectively, to adjust risks for case-mix, and to understand the mechanisms of operative stroke. Methods-: We performed a systematic review of all studie...

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Main Authors: Kittipan Rerkasem, Peter M. Rothwell
Format: Journal
Published: 2018
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Online Access:https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=70349854790&origin=inward
http://cmuir.cmu.ac.th/jspui/handle/6653943832/49296
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spelling th-cmuir.6653943832-492962018-08-16T02:16:33Z Systematic review of the operative risks of carotid endarterectomy for recently symptomatic stenosis in relation to the timing of surgery Kittipan Rerkasem Peter M. Rothwell Medicine Nursing Background and Purpose-: Reliable data on the risk of carotid endarterectomy (CEA) in relation to timing of surgery are necessary to plan CEA most effectively, to adjust risks for case-mix, and to understand the mechanisms of operative stroke. Methods-: We performed a systematic review of all studies published from 1980 to 2008 inclusive that reported the risk of stroke and death due to CEA in relation to the time between presenting symptom and surgery. Pooled estimates of risk by the time since the last event were obtained by Mantel-Haenszel meta-analysis. Results-: Of 494 published operative series, only 47 stratified risk by timing of surgery. The pooled absolute risks of stroke and death after urgent CEA were high in patients with stroke-in-evolution (20.2%, 95% CI 12.0 to 28.4) and in patients with crescendo TIA (11.4%, 6.1 to 16.7), with no trends toward reduced risks in more recent studies. However, there was no significant difference between early and later CEA in neurologically stable patients with recent TIA or nondisabling stroke (<1 week versus ≥1 week, OR=1.2, 0.9 to 1.7, P=0.17; <2 weeks versus ≥2 weeks, OR=1.2, 0.9 to 1.6, P=0.13). Conclusions-: Emergency endarterectomy for stroke-in-evolution has a high operative risk, but the risk may be somewhat lower in patients with crescendo TIA. Surgery in the first week in neurologically stable patients with TIA or minor stroke is not associated with a substantially higher operative risk than delayed surgery. More data are required on the risk and benefit of more urgent surgery for TIA and minor stroke and for early versus delayed surgery in patients with major nondisabling stroke. © 2009 American Heart Association, Inc. 2018-08-16T02:14:05Z 2018-08-16T02:14:05Z 2009-10-01 Journal 00392499 2-s2.0-70349854790 10.1161/STROKEAHA.109.558528 https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=70349854790&origin=inward http://cmuir.cmu.ac.th/jspui/handle/6653943832/49296
institution Chiang Mai University
building Chiang Mai University Library
country Thailand
collection CMU Intellectual Repository
topic Medicine
Nursing
spellingShingle Medicine
Nursing
Kittipan Rerkasem
Peter M. Rothwell
Systematic review of the operative risks of carotid endarterectomy for recently symptomatic stenosis in relation to the timing of surgery
description Background and Purpose-: Reliable data on the risk of carotid endarterectomy (CEA) in relation to timing of surgery are necessary to plan CEA most effectively, to adjust risks for case-mix, and to understand the mechanisms of operative stroke. Methods-: We performed a systematic review of all studies published from 1980 to 2008 inclusive that reported the risk of stroke and death due to CEA in relation to the time between presenting symptom and surgery. Pooled estimates of risk by the time since the last event were obtained by Mantel-Haenszel meta-analysis. Results-: Of 494 published operative series, only 47 stratified risk by timing of surgery. The pooled absolute risks of stroke and death after urgent CEA were high in patients with stroke-in-evolution (20.2%, 95% CI 12.0 to 28.4) and in patients with crescendo TIA (11.4%, 6.1 to 16.7), with no trends toward reduced risks in more recent studies. However, there was no significant difference between early and later CEA in neurologically stable patients with recent TIA or nondisabling stroke (<1 week versus ≥1 week, OR=1.2, 0.9 to 1.7, P=0.17; <2 weeks versus ≥2 weeks, OR=1.2, 0.9 to 1.6, P=0.13). Conclusions-: Emergency endarterectomy for stroke-in-evolution has a high operative risk, but the risk may be somewhat lower in patients with crescendo TIA. Surgery in the first week in neurologically stable patients with TIA or minor stroke is not associated with a substantially higher operative risk than delayed surgery. More data are required on the risk and benefit of more urgent surgery for TIA and minor stroke and for early versus delayed surgery in patients with major nondisabling stroke. © 2009 American Heart Association, Inc.
format Journal
author Kittipan Rerkasem
Peter M. Rothwell
author_facet Kittipan Rerkasem
Peter M. Rothwell
author_sort Kittipan Rerkasem
title Systematic review of the operative risks of carotid endarterectomy for recently symptomatic stenosis in relation to the timing of surgery
title_short Systematic review of the operative risks of carotid endarterectomy for recently symptomatic stenosis in relation to the timing of surgery
title_full Systematic review of the operative risks of carotid endarterectomy for recently symptomatic stenosis in relation to the timing of surgery
title_fullStr Systematic review of the operative risks of carotid endarterectomy for recently symptomatic stenosis in relation to the timing of surgery
title_full_unstemmed Systematic review of the operative risks of carotid endarterectomy for recently symptomatic stenosis in relation to the timing of surgery
title_sort systematic review of the operative risks of carotid endarterectomy for recently symptomatic stenosis in relation to the timing of surgery
publishDate 2018
url https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=70349854790&origin=inward
http://cmuir.cmu.ac.th/jspui/handle/6653943832/49296
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