22. European Stroke Conference 5 Vascular surgery and neurosurgery 17:10 - 17:20 Early carotid endarterectomy in symptomatic patients with large brain infarcts A. Oldag1, M. Glaser2, C. Campe3, F. Meyer4, Z. Halloul5, M. Goertler6 Vascular and Stroke Center, Department of Neurology,Otto-von-Guericke-University of Magdeburg, Magdeburg, GERMANY1,Vascular and Stroke Center, Department of Neurol-ogy, Otto-von-Guericke-University of Magdeburg, Magdeburg, GERMANY2, Vascular and Stroke Center, Department of Neurology, Magdeburg, GERMANY3, Vascular an Stroke Cen-ter, Department of General, Abdominal and Vascular Surgery,Otto-von-Guericke-University of Magdeburg, Magdeburg, GERMANY4, Vascular an Stroke Center, Department of General, Ab-dominal and Vascular Surgery,Otto-von-Guericke-University of Magdeburg, Magdeburg, GER-MANY5, Vascular and Stroke Center, Department of Neurology,Otto-von-Guericke-University of Magdeburg, Magdeburg, GERMANY6 Background: To assess incidence of cerebral complications as pivotal outcome parameter in patients with symptomatic carotid stenosis and large brain infarction who underwent early ca-rotid endarterectomy (CEA). Methods: Patients with symptomatic carotid stenosis were sub-jected to patch CEA. Infarct size was measured in the axial CT/MRI-slice demonstrating the largest infarct dimension and was categorized as large (> 4 square cm), small (≤ 4 square cm), or absent. Perioperative cerebral complications were classified as focal, i.e., causing stroke-like symptoms, and non-focal, such as prolonged unconsciousness, delirium, epileptic seizure, or headache, summarized as postoperative encephalopathy. Results: 459 consecutive symptomatic patients were enrolled of whom 192 (41.8%) underwent early (≤ 2 weeks) CEA. Postopera-tive encephalopathy occurred in 6 of 84 (7.1%) with large infarct, 3 of 163 (1.8%) with small infarct, and 3 of 209 (1.4%) without infarct. Relative risk compared to patients without infarct was 5.4 (95% CI, 1.3 to 21.9) for patients with large infarct and 1.3 (95% CI, 0.3 to 6.6) for pa-tients with small infarct. Relative risk did not differ in early and delayed CEA. At multivariate analysis, intraoperative blood pressure, i.e., median of mean arterial blood pressure at CEA in the upper quartile (> 120 mm mercury) was the only independent predictor for postoperative encephalopathy (adjusted OR, 7.6; 95% CI, 2.0 to 29.0; P = 0.003) in addition to large infarct (adjusted OR, 4.3; 95% CI, 1.0 to 18.0; P = 0.047). Stroke (fatal/with persisting deficit) oc-curred in 1 (1.2%) patient with large infarct, 12 (7.4%) with small infarct, and 9 (4.2%) without infarct. Corresponding relative risks were 0.3 (95% CI, 0.0 to 2.2) for patients with large infarct and 1.8 (95% CI, 0.7 to 4.4) for patients with small infarct. Conclusions: Risk of non-focal en-cephalopathic complications but not risk of stroke is increased in patients with large infarct at early (and delayed) CEA. Figure 1: Plot of proportion of patients with stroke or death within 30 days of CEA in symp-tomatic carotid stenosis trials by mid-point year of recruitment. Figure 2: Plot of proportion of patients with stroke or death within 30 days of CEA in sympto-matic carotid stenosis trials, by % of patients with high cholesterol at baseline within each trial, with fitted meta-regression line. 64 © 2013 S. Karger AG, Basel Scientific Programme
Karger_ESC London_2013
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