Angle N – This retrospective study assessed early (<2 weeks) carotid endarterectomy (CEA) performed by a single surgeon in stroke patients (N = 183) over a 12–year period to determine whether early CEA after stroke was safe, without shunting. It was concluded that early CEA (<72 hours) can be performed safely in the absence of shunting and without an increase in postoperative stroke, morbidity, or mortality. Shunting during CEA can be dramatically reduced with electroencephalography and somatosensory monitoring. Early CEA for stroke is not associated with an early risk of recurrent stroke.

Methods

• The decision to shunt was based only on defined changes in continuous electroencephalography and somatosensory evoked potentials, reflecting intraoperative ischemia.
• The degree of internal carotid artery (ICA) stenosis, preoperative neurologic symptoms, and medications was assessed.
• Thirty–day outcomes were tabulated, including stroke, transient ischemic attack, death, and other major complications.

Results

• Of the 451 CEAs performed, 220 (49%) were for symptomatic disease, of which 183 had a documented stroke.
• The 72–hour perioperative stroke rate for the whole CEA group was 0.66%.
• Approximately 88% of the stroke cohort received CEA within 72 hours, and the rest within 5 days.
• The mean pre–CEA modified Rankin scale was 3.8 in the stroke cohort, and 1 patient had a new contralateral stroke.
• The frequencies of 30–day stroke and death rates were 5 (1.1%) each. One stroke occurred intraoperatively, while the remaining 4 occurred within 30 days.
• Indication for intraoperative shunting does not include a recent stroke, contralateral occlusion of ICA, or contralateral high–grade ICA stenosis.