Carotid endarterectomy in the early and delayed period of acute cerebral circulation disturbance
AbstractIntroduction. Currently, there are no unified recommendations on the timing of surgical treatment regarding the development of the first symptoms of carotid stenosis. Accordingly, the question of the most effective and, at the same time, safer deadlines for the implementation of the carotid endarterectomy remains open.
The objective of this meta-analysis is comparison of the results of carotid endarterectomy in the early and delayed periods of acute cerebrovascular accident.
Material and methods. The meta-analysis included 11 clinical trials. The results of treatment of 5003 patients from 10 studies were analyzed, in which early CEE was related to surgery performed within the first 14 days, and delayed – more than 14 days after the onset of the first symptoms of carotid stenosis. Another 4 publications studied the results of carotid endarterectomy before and more than 1 month (28–30 days) from the onset of stroke in 873 patients.
Results. As a result of the analysis of the incidence of perioperative complications (bleeding, hematomas, damage to the cranial nerves), transient ischemic attack or acute cerebrovascular accident, myocardial infarction, deaths within 30 days after carotid endarterectomy, as well as acute cerebrovascular accident, lethal There were no statistically significant differences between the groups of early and delayed surgery in patients who underwent surgery within the first 14 days from the onset of the first symptoms of carotid artery stenosis. When comparing data on the same indicators in patients who underwent surgery within the first month (28–30 days) from the onset of the first symptoms of carotid artery stenosis, no statistically significant differences were found between the groups of early and delayed surgery.
Conclusion. The meta-analysis of the incidence of perioperative complications and deaths after carotid endarterectomy in the early and delayed period of acute cerebrovascular accident in patients with carotid artery stenosis showed comparable results, regardless of the timing of the surgical intervention.
Funding. The study had no financial support.
Conflict of interest. The authors declare no conflicts of interest.
Authors’ contribution. Study conception and design – Gavrilenko A.V.; data collection and handling – Nekrasov D.A.; statistical processing – Nekrasov D.A.; draft manuscript preparation – Nekrasov D.A.; manuscript revision – Gavrilenko A.V.
For citation: For citation: Nekrasov D.A., Gavrilenko A.V. Carotid endarterectomy in the early and delayed period of acute cerebral circulation disturbance Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (3): 129–39. DOI: https://doi.org/10.33029/1027-6661-2023-29-3-129-139 (in Russian)
Keywords: carotid artery stenosis; ischemic stroke; carotid endarterectomy; transient ischemic attack; time interval; long-term follow-up period; complications; acute cerebrovascular accident
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