Carotid Endarterectomy is often not Possible after an Unheralded Stroke: Unheralded Stroke in Carotid Artery Stenosis

被引:1
作者
Pini, Rodolfo [1 ]
Faggioli, Gianluca [1 ]
Muscari, Antonio [2 ]
Rocchi, Cristina [1 ]
Palermo, Sergio [1 ]
Vacirca, Andrea [1 ]
Gallitto, Enrico [1 ]
Gargiulo, Mauro [1 ]
机构
[1] Univ Bologna, Div Vasc Surg, IRCCS Azienda Ospedaliero, Bologna, Italy
[2] Univ Bologna, Dept Med & Surg Sci, Bologna, Italy
关键词
Stroke; Carotid artery stenosis; Endoarterectomy; Asymptomatic;
D O I
10.1016/j.jstrokecerebrovasdis.2020.105594
中图分类号
Q189 [神经科学];
学科分类号
071006 ;
摘要
Objectives: The ongoing literature recommends carotid endarterectomy (CEA) primarily for patients with neurological symptoms, however CEA can be precluded by the onset of a severe stroke or a total carotid occlusion. The present study aims to evaluate the effect of unheralded strokes in patients with a previously asymptomatic carotid stenosis (ACS) possibly considered for CEA. Materials and Methods: From 2009 to 2019, patients with an unheralded stroke from an ACS were considered. By neurological examination, patients were divided in unfit-for-CEA (uCEA) - either for the severity of the stroke (according to modified Rankin-Scale - mRS) or the onset of a total carotid occlusion - and patients submitted to CEA. Predictors for uCEA and stroke severity were evaluated. Results: Over a total of 532 patients with symptomatic carotid stenosis, 277 (52%) with unheralded stroke were included in the study. One hundred and one (36%) were considered uCEA: 64(23%) due to their neurological conditions (mRS:5) and 37 (13%) because of the onset of carotid occlusion. One hundred seventy-six (64%) patients underwent CEA. The preoperative medical therapy was similar in uCEA vs CEA patients. Age-80 years and female sex were independently associated with uCEA (OR:5.9, 95%CI:3.1-11.4, P<.01; OR:3.9, 95%CI:2.0-7.6, P<.01. respectively). Patients submitted to CEA had mRS: 0-2 in 102(37%) cases and mRS:3-4 in 74 (27%). The contralateral carotid occlusion (CCO) was independently associated with mRS:3 -4 (OR:8.4, 95%CI 1.8-79, P=.01). Postoperative stroke rate after CEA was 2.9% (4/ 167); patients with preoperative mRS:3-4 had a higher risk for postoperative stroke compared to those with mRS:0-2 (5.9% vs. 0%. P=.02). Conclusions: An unheralded stroke in patients with ACS leads to a severe neurological damage in more than half of cases, either precluding CEA (36%) or increasing the risk of postoperative complications (27%). Female sex, age >= 80 and CCO are independent predictors of these occurrences and should be considered in ACS patients.
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