American Surgical Association

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Timing of Carotid Endarterectomy After Stroke
Adam Tanious*1, Alexander B. Pothof*2, Laura Boitano*1, Alaska Pendleton*1, Linda J. Wang*1, Gert J. de Borst*3, David W. Rattner1, Marc L. Schermerhorn2, Mohammad H. Eslami*4, Mahmoud B. Malas*5, Matthew Eagleton*1, W. Darrin Clouse*1, Mark Conrad*1
1Massachusetts General Hospital, Boston, MA;2Beth Israel Deaconess Medical Center, Boston, MA;3University Medical Center, Utrecht, Netherlands4University of Pittsburgh, Pittsburgh, PA;5Johns Hopkins University, Baltimore, MD

Introduction:
Timing of carotid intervention in post-stroke patients is widely debated. Our objective was to identify the postoperative risk associated with different timing intervals of repair.
Methods:
Utilizing Vascular Quality Initiative data, all carotid interventions performed on stroke patients between the years 2012-2017 were queried. Patients were then stratified based on the timing of surgery from their stroke (< 48hrs, 3-7 days, 8-14 days, > 15 days). Major outcomes included postoperative stroke, death, and MI.
Results:
A total of 8404 patients were included being predominantly male (5281, 62.8%), with an average age of 69 (+/- 10). Table 1 displays the outcome variables overall and broken down by timing groups with associated p-values. Patients treated at greater than 8 days showed significantly less risk of postoperative combined stroke/death as well as postoperative stroke. There were no significant differences in postoperative stroke or death between the 8-14 and greater than 15 days groups.
Multivariate regression analysis showed that delayed timing of surgery between 3-7 days was protective for postoperative stroke/death (p=.003) and any postoperative complication (p=.028). Delaying surgery to greater than 8 days after stroke was protective for postoperative stroke/death (p<.001), post-operative stroke (p<.001), and any postoperative complication (p<.001).
Conclusion:
Carotid revascularization should occur no sooner than 48 hours after index stroke event. Surgeons should strive to operate between 8-14 days to protect against postoperative stroke/death.


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