The Carotid Surgery for @entity385 trial: a prospective observational study on carotid endarterectomy in the early period after XXXX .

@entity1 @entity64 @entity548 @entity1188 @entity583 @entity1779 @entity385
OBJECTIVE: The purpose of this study was to examine the safety of carotid endarterectomy (CEA) within 6 weeks after a nondisabling carotid-related @entity385 . Endpoints were the perioperative @entity64 or mortality rate and the incidence rate of cerebral bleedings. METHODS: This prospective observational multicenter trial was performed in community and university centers. One hundred sixty-four hospitalized @entity1 with nondisabling carotid-related @entity385 were included. The @entity1 were identified clinically with the modified Rankin scale (initial neurologic deficit grade >/= 2, n = 160). Four @entity1 with evidence of ischemic territorial infarction on cerebral computed tomographic (CT) scan but no persisting functional deficit were also included. CEA was performed within 6 weeks after @entity64 . Neurologic examinations were performed initially, before surgery, 3 days after surgery, and 6 weeks after CEA. Worsening of more than 1 grade on the Rankin scale was considered as a new @entity64 or @entity64 extension. Unenhanced CT scans of the brain were performed before and after surgery. CT scans were evaluated blind to clinical @entity1 data. Statistical analysis included univariate and multivariate analysis. RESULTS: The combined @entity64 or mortality rate within 30 days after CEA was 6.7%. Ten @entity1 had a new @entity64 or @entity64 extension, and one @entity1 died after surgery of a @entity583 . One @entity1 (0.6%) had @entity1779 , and in 10 @entity1 , hemorrhagic transformation within the preexisting @entity1188 was detected but no @entity1188 extension was observed. In the multivariate analysis, American Society of Anesthesiology (ASA) grades III and IV and decreasing age were significant predictors for an increased perioperative risk. @entity1 with a higher risk profile (ASA classification grades III and IV) had a high perioperative risk when CEA was performed within the first 3 weeks (14.6% versus 4.8% beyond 3 weeks). @entity1 without severe concomitant diseases (ASA grades I/II) had a low perioperative risk of 3.4% if CEA was performed within the first 3 weeks. CONCLUSION: Early CEA within 6 weeks after a carotid-related @entity385 can be performed with a perioperative @entity64 or mortality rate comparable with the results reported in the European Carotid Surgery Trial and the North American Symptomatic Carotid Endarterectomy Trial. The risk of @entity548 is low. ASA grades III and IV and decreasing age were predictive of an increased perioperative risk, especially if CEA was performed within the first 3 weeks. @entity1 at low risk can undergo operation safely within the first 3 weeks. Individual @entity1 selection in an interdisciplinary approach between neurologists, anesthesiologists, and vascular surgeons remains mandatory in these @entity1 .
