Objective

The risk of ipsilateral neurological recurrence (NR) was assessed in patients awaiting carotid endarterectomy (CEA) due to symptomatic carotid artery stenosis and whether current national guidelines of performing CEA within 14 days are adequate in present day practice.

Methods

This was a retrospective multicentre observational cohort study. Patients scheduled for CEA due to symptomatic carotid artery stenosis in a five year period, 1 January 2014 to 31 December 2018, from four centres were included. Data from the Danish Vascular Registry (www.karbase.dk), operative managing systems, and electronic medical records were reviewed.

Results

In total, 1 125 patients scheduled for CEA were included and 1 095 (97%) underwent the planned surgery. During a median delay from index event to CEA of 11 days (interquartile range 8–16 days), 40 patients (3.6%; 95% confidence interval [CI] 2.5%–5%) experienced a NR. One third were minor strokes (n = 12, 30%); half were transient ischaemic attacks (TIA) (n = 22, 55%); and amaurosis fugax accounted for 15% (n = 6). Twenty-six (2%) CEA procedures was cancelled, of which one was due to a disabling recurrent ischaemic event (aphasia). There were no deaths or major strokes in the waiting time for CEA. Best medical treatment (BMT) with platelet inhibitory or anticoagulation drugs and a statin was initiated in nearly all patients (98%) at first assessment. The overall 30 day risk of a post-operative major event (death or stroke) was (Kaplan–Meier [KM] estimate) 2.7% (95% CI 1.8–3.8), and not significantly correlated with the timing of surgery. Most (69%) occurred within the first three days. One, two, and three year mortality rate for CEA patients was (KM estimate) 4.8%, 7.8%, and 11.5% respectively.

Conclusion

In symptomatic carotid artery stenosis patients awaiting CEA, very few NRs occurred within 14 days. Institution of immediate BMT in specialised TIA/stroke units followed by early, but not necessarily urgent, CEA is a reasonable course of action in patients with high grade symptomatic carotid artery stenosis.

中文翻译：

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等待颈动脉内膜切除术时神经系统复发的低风险：丹麦多中心研究的结果

客观的

对因症状性颈动脉狭窄而等待颈动脉内膜切除术 (CEA) 的患者的同侧神经系统复发 (NR) 的风险进行评估，以及目前在 14 天内执行 CEA 的国家指南在当前实践中是否足够。

方法

这是一项回顾性多中心观察性队列研究。纳入了在 2014 年 1 月 1 日至 2018 年 12 月 31 日的五年期间，来自四个中心的因症状性颈动脉狭窄而计划接受 CEA 的患者。审查了来自丹麦血管登记处 (www.karbase.dk)、手术管理系统和电子病历的数据。

结果

总共包括 1 125 名计划接受 CEA 的患者，1 095 名 (97%) 接受了计划的手术。在从指标事件到 CEA 的中位延迟 11 天（四分位距为 8-16 天）期间，40 名患者（3.6%；95% 置信区间 [CI] 2.5%-5%）经历了 NR。三分之一是轻微中风（n  = 12, 30%）；一半是短暂性脑缺血发作 (TIA) ( n  = 22, 55%)；一过性黑蒙占15%（n = 6）。二十六 (2%) 项 CEA 程序被取消，其中一项是由于致残的复发性缺血事件（失语症）。在等待CEA的时间里，没有人死亡或中风。在第一次评估时，几乎所有患者 (98%) 都开始使用血小板抑制或抗凝药物和他汀类药物进行最佳药物治疗 (BMT)。术后主要事件（死亡或中风）的总体 30 天风险为（Kaplan-Meier [KM] 估计值）2.7%（95% CI 1.8-3.8），并且与手术时间没有显着相关性。大多数 (69%) 发生在前三天。CEA 患者的一年、两年和三年死亡率（KM 估计）分别为 4.8%、7.8% 和 11.5%。

结论

在等待 CEA 的有症状的颈动脉狭窄患者中，14 天内发生的 NR 非常少。在专门的 TIA/卒中单位立即进行 BMT，然后早期但不一定紧急的 CEA 是患有高度有症状的颈动脉狭窄患者的合理行动方案。