XXXX after carotid surgery: the importance of clinical presentation and preoperative timing.

@entity1 @entity64 @entity63 @entity256 @entity397 @entity731 @entity385
BACKGROUND AND PURPOSE: Carotid endarterectomy (CEA) of stable @entity731 plaques is associated with an increased risk for @entity256 . @entity1 with transient @entity63 attack and @entity1 with and @entity64 have relatively unstable @entity731 plaques. However, carotid plaques stabilize over time after a cerebrovascular event due to plaque repair after @entity397 . These findings raised 2 questions: (1) Is preoperative clinical presentation related to @entity256 after CEA? (2) Does delayed revascularization result in a higher risk for @entity256 compared with CEA in the short term after a cerebrovascular event? METHODS: Between 2002 and 2009, 1203 @entity1 undergoing CEA were included. The impact of clinical presentation on the occurrence of @entity256 1 year after CEA was investigated and corrected for cardiovascular risk factors, medication use, and type of arteriotomy closure. Patency was assessed with standardized duplex ultrasound imaging at 1 year after CEA. @entity256 was defined as recurrent luminal narrowing >= 50% at the endarterectomy site. RESULTS: At 1 year of follow-up, @entity256 was observed more frequently in asymptomatic @entity1 than in @entity1 with transient @entity63 attack and @entity1 with @entity64 . The adjusted odds ratio (95% CI) for @entity256 was 0.56 (0.35 to 0.89) for @entity1 with transient @entity63 attack and 0.49 (0.27 to 0.87) for @entity1 with @entity64 compared with asymptomatic @entity1 . Subgroup analysis showed an increased risk for @entity256 if CEA was performed >30 days after @entity64 (adjusted OR, 2.23; 1.02 to 5.73). CONCLUSIONS: Asymptomatic @entity1 have an increased risk for @entity256 at 1 year after CEA compared with @entity1 with transient @entity385 and @entity1 with @entity64 . CEA within 30 days after @entity64 is associated with a decreased risk of @entity256 , which supports the current strategy for early surgical intervention after @entity64 .
