Early Carotid Endarterectomy for Symptomatic Internal Carotid Artery Stenosis in the Acute Ischemic Stroke

Objective: To research the results of the microsurgical treatment of symptomatic internal carotid artery stenosis by Carotid Endarterectomy in the acute period of a stroke that were performed in the Neurosurgery Department of IMSP IMU. Materials and Methods: A retrospective data collection was conducted on all consecutive patients  surgically treated for an extra-cranial internal carotid artery (ICA) hemodynamic  stenosis in the Neurosurgery Department of the Emergency Medicine Institute,in Chisinau (Rebublic of Moldova),between February 2019 and March 2021.All patients undergoing ICA endarterectomy for symptomatic carotid stenosis (SCS) within 48 hours and 14 days after the acute neurologic onset were included in the present study.Outcomes were evaluated by a prospective follow-up. Primary outcomes were the rate of postoperative ipsilateral stroke, myocardial infarction (MI), peripheral nerve injury, hematoma in the operating area and death.Secondary outcomes were the rate of local and systemic complications.The results were stratified according NIHSS score and comorbidities 30 days after surgery,and a multivariate analysis were performed in order to define any correlation between preoperative data and postoperative outcomes. Results: A total of 40 patients (10 %, n 4 bilateral and 90%, n 36 unilateral) underwent carotid endarterectomy (CEA) for hemodynamically significant ICA stenosis. According to inclusion criteria (22% women  vs 78% men; median age 64 years, range: 54-76; median preoperative NIHSS score 4, range 0-18) all patients affected by SCS were enrolled in the present study. Median delay for surgery was 6 days (range: 2-14).During in-hospital post-operative period the combined death/stroke/MI rate was 0%.In-hospital NIHSS score improved post-operatively of more than 2 points (range 0-12) in 45.7% of cases.Microsurgical CEA is accompanied,in most cases by the regression of neurological symptoms and it is not correlated with the increased risk for a hemorrhagic transformation.No local and systemic complications were registered.The stratification of outcomes according to NIHSS status, sex, comorbidities did not show any statistical relation neither at 30 days nor at the long term-follow up. Conclusion: In properly selected patients with a SCS, affected by an acute ischemic stroke, early carotid endarterectomy can be performed without any complications or worsening of neurological status in comparison with similar cases in a longer period after a stroke.