London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 461 333 Vascular surgery and neurosurgery Perioperative complications in early an very early carotid endarterectomy in symptomatic pa-tients M. Glaser1, A. Oldag2, A. Rappe3, F. Meyer4, Z. Halloul5, M. Goertler6 Vascular and Stroke Center, Department of Neurology, Magdeburg, GERMANY1, Vascular and Stroke Center, Department of Neurology, Magdeburg, GERMANY2, Vascular and Stroke Center, Department of General, Abdominal and Vascular Surgery, Magdeburg, GERMANY3, Vascular and Stroke Center, Department of General, Abdominal and Vascular Surgery, Magdeburg, GERMANY4, Vascular and Stroke Center, Department of General, Abdominal and Vascular Surgery, Magdeburg, GERMANY5, Vascular and Stroke Center, Department of Neurology, Magdeburg, GERMANY6 Background: To assess perioperative risk and to evaluate variables responsible for a potential time-dependent perioperative risk in very early carotid endarterectomy (CEA) after an ischemic event due to severe carotid stenosis. Methods: Patients with symptomatic carotid stenosis were subjected to patch CEA. The ischemic event preceding patient’s first contact with our Vascular and Stroke Center was interpreted as the ischemic index event. CEA was classified as very early (≤ 48 hours between ischemic index event and CEA), early (3 to 14 days), and delayed (15 to 180 days). Persisting stroke (> 7 days) and death within 30 days of CEA was considered as pivotal outcome complication. Results: Forty four (9.6%) patients underwent very early CEA, 148 (32.2%) early CEA, and 267 (58.2%) delayed CEA. Median time from index ischemia to CEA was 1.2 days (IQR, 0.6 to 1.9) in patients with very early CEA, 7.4 days (IQR, 4.7 to 10.6) in patients with early CEA, and 43.3 days (IQR, 24.4 to 77.3) in those with delayed CEA. Persisting stroke or death occurred in 3 (6.8%) very early CEA, 10 (6.8%) early CEA, and 12 (4.5%) delayed CEA (P = 0.331). Thirty (68.2%) patients with very early, 70 (47.3%) with early, and 68 (25.5%) with delayed CEA had recurrent events prior to CEA (P < 0.001) and received dual antiplatelet agents at 23 (52.3%) very early CEA, 40 (27.0%) early CEA, and 44 (16.5%) delayed CEA. Conclusions: Risk of perioperative stroke and death at very early CEA was not increased in our pa-tients compared to early and delayed CEA which contradicts a prior large register study. We hypoth-esize that more intensive antiplatelet therapy in very early CEA and its rapid onset due to its start with an intravenous loading dose (acetylsalicylic acid) or a bolus application (clopidogrel) might be responsible for this result. 334 Vascular surgery and neurosurgery Low stroke rate perioperative and during long term follow-up after extracranial-intracranial bypass – a Danish perspective P. von Weitzel-Mudersbach1, S. Rosenbaum2, L.S. Rasmussen3, T. Obbekjaer4, N. Sunde5, D. Krieger6, G. Andersen7 The Danish Stroke Center, Department of Neurology, Aarhus University Hospital, Aarhus, DENMARK1, Department of Neurology, Bispebjerg University Hospital, Copenhagen, DEN-MARK2, Department of Neurology, Bispebjerg University Hospital, Copenhagen, DENMARK3, The Danish Stroke Center, Department of Neurosurgery, Aarhus University Hospital, Aarhus, DEN-MARK4, The Danish Stroke Center, Department of Neurosurgery, Aarhus University Hospital, Aar-hus, DENMARK5, Department of Neurology, Bispebjerg University Hospital, Copenhagen, DEN-MARK6, The Danish Stroke Center, Department of Neurology, Aarhus University Hospital, Aarhus, DENMARK7 Background: Extracranial-intracranial bypass (EC-IC bypass) in patients with symptomatic atherosclerotic inter-nal carotid artery occlusion (SAICAO) has failed to reduce stroke in the recent published random-ized COSS-trial. Stroke reduction in operated patients during follow-up was balanced by a high perioperative stroke rate. Reducing the perioperative stroke risk, EC-IC-bypass may be effective in preventing long-term risk of stroke in patients with SAICAO Methods: In Denmark, patients with suspected SAICAO are referred to two vascular reference centers: Bis-pebjerg Hospital in Copenhagen and Aarhus University Hospital. All patients are examined with H2 150 PET including Acetolamid challenge. Patients with haemodynamic failure, defined as severe impaired or reversed flow reserve, are referred to EC-IC bypass operation to the Department of Neu-rosurgery Charité Berlin, Germany, a high volume center performing about 100 revascularizing op-erations per year. In the period 2007-2012 we registered prospectively stroke and death through 30 days after operation, ipsilateral stroke at the end of follow-up and bypass patency. Results: EC-IC bypass was performed in 29 patients with SAICAO, in three patients with symptomatic com-mon carotid artery occlusion and in one patient with severe atherosclerotic stenosis of the middle cerebral artery. Median age was 64 years. Mean follow-up was 1006 days (range 193;2003). Stroke rate after 30 days was 3%, no further ipsilateral strokes occurred during follow-up. Bypass patency were available in 29 patients after mean 747 days, patency rate was 93%. The two occlusions oc-curred few days after operation. Conclusion: Perioperative stroke rate in EC-IC bypass operation, performed at a highly experienced center, is low. Given the low long-term stroke risk in operated patients, which also was seen in the COSS trial, EC-IC-bypass still may be an option in patients with SAICAO
Karger_ESC London_2013
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