SVS: Minimizing treatment time for CEA improves neurological outcomes

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BOSTON—Minimizing the time for carotid endarterectomy (CEA) in patients reduces the risk of recurrence and improves neurological outcomes, according to the results of a study presented at the 2010 Society of Vascular Surgery (SVS) annual meeting on June 10.

“We know that neurologic recurrence risk is very high in the first few weeks following an event,” said Laura Capoccia, MD, of the University of Rome in Italy. A previous study in 2009 showed that during the first 72 hours of the onset of symptoms, incidence of stroke recurrence rose by 20 percent.

During the study, Capoccia and colleagues evaluated the safety and other benefits of CEA on 62 patients, who had a stenosis of 50 percent or greater and acute stroke between January 2005 and December 2009.

The researchers assessed patients using the National Institute of Health Stroke Scale (NIHSS) on admission or before surgery and at hospital discharge. They used 30-day neurological mortality as the primary endpoint and also evaluated NIHSS score changes and hemorrhagic or ischemic stroke recurrence.

The 62 interventions were all performed between two and 280 hours from the onset of symptoms and had a mean of 34 hours.

According to Capoccia, results showed that there were no neurological mortality, brain hemorrhagic infarction or stroke recurrence and MI occurred in one patient.

During the duration of the study,  NIHSS scores decreased in all but four patients and no new ischemic lesions were detected. Mean NIHSS scores were 7.05 on admission and 3.11 at hospital discharge.

Capoccia said that most importantly during the study were the results that showed that patients who present with a NIHSS score of more than eight points at admission saw the most clinical benefit.

“The presence of a major stroke, or a high NIHSS score, does not contraindicate early surgery,” Capoccia said.

And, while the American Academy of Neurology guidelines suggest treating carotid stenosis within two weeks of the onset of symptoms is best, according to the study, earlier treatment time can significantly reduce adverse events and mortality.

During her presentation, Capoccia concluded that “the new and challenging aim of CEA is to rescue substantial brain tissue as soon as possible before cell death occurs.

"According to the absence of stroke recurrence in patients, we can say that early CEA is going to be effective in preventing neurological recurrence in symptomatic patients,” Capoccia concluded.