Timing of carotid artery endarterectomy after stroke

Carotid endarterectomy has been advocated to prevent further neurologic deterioration in patients who have had a stroke. Previous reports have shown that endarterectomy within 2 weeks of a stroke is associated with high morbidity and mortality rates presumably from hemorrhagic complications in the brain. Some recommend a 2- to 6-week waiting period after a stroke, but the safety of operation in the interval of time beyond 2 weeks has not been documented in the literature. The present study investigated the morbidity and mortality rates of 352 consecutive carotid endarterectomies. Three hundred three endarterectomies were performed on patients with symptoms other than stroke. Forty-nine endarterectomies were performed on patients with a deficit lasting more than 24 hours. Of these, 27 carotid endarterectomies were performed in an interval less than 5 weeks after initial stroke (early interval) and 22 operations were performed in a 5- to 20-week interval after stroke (late interval). Five strokes occurred in the 27 patients operated on within 5 weeks, an incidence of 18.5%; none of the patients operated on after 5 weeks exhibited worsening of their preoperative neurologic status. With the use of Fisher's exact test to compare these two intervals, the results were found to be significant (p less than 0.05). The cause of stroke in those operated on in the early interval was investigated by postoperative CT scans; in only one instance was there a hemorrhagic infarct of the ipsilateral hemisphere. The literature suggests that a variety of intracerebral vascular changes render the brain more susceptible to reinfarction soon after stroke. This study suggests an unstable situation in the 5-week interval following stroke that contraindicates carotid endarterectomy.