Early reintervention improves outcomes in patients with stroke after carotid endarterectomy: observational study.

Abstract

Background: Thrombosis of the reconstructed artery after carotid endarterectomy (CEA) may be cause of the postoperative stroke or transitory ischemic attack (TIA). Secondary procedure with the aim to restore carotid flow is required in order to potentially improve patients' condition. Results of such intervention are scarce in the literature. The aim of this study was to assess the outcomes of early reintervention in patients who developed early neurological complications after CEA.

Methods: A retrospective cohort study was conducted on 36 patients who underwent urgent reoperation with synthetic graft interposition after CEA due to early postoperative neurological deficits. Patient data, including demographics, comorbidities, neurological scores, and surgical details, were collected. Post-revision outcomes were evaluated using the Rankin and NIHSS scores. Patients with intraoperative stroke or those with postoperative stroke who were not operated were excluded from the study. Statistical analyses were performed using McNemar's chi-square and Wilcoxon's signed-rank tests, with multivariate analysis to assess predictive factors for recovery.

Results: Out of 36 patients, 94.44% experienced neurological improvement after reoperation. The median Rankin score decreased from 2 to 1 (P<0.001), and the median NIHSS score decreased from 10 to 4 (P<0.001). Significant improvement was observed in arm, leg, and speech deficits, though in patients with consciousness impairments limited recovery was noted. Higher pre-revision Rankin scores and the presence of exulcerated plaques on primary procedure were predictive of poorer outcomes.

Conclusions: Detect of early postoperative neurological deficit after CEA is very important. This study showed significant clinical improvement in most patients reoperated immediately with synthetic graft interposition. Further comparison of other potential strategies, including conservative therapy, might bring more data on how to deal with such a difficult complication.