Vascular Surgery Group, Department of Cardiovascular Sciences, Robert Kilpatrick Clinical Sciences Building, University of Leicester, Leicester LE2 7LX, UK.
Eur J Vasc Endovasc Surg. 2011 Feb;41(2):222-8. doi: 10.1016/j.ejvs.2010.10.017. Epub 2010 Dec 3.
The highest risk of recurrent stroke after suffering a transient ischaemic attack (TIA) or minor stroke is during the first 7-14 days. Contemporary guidelines recommend that carotid endarterectomy (CEA) should be performed within this time period, but there are concerns regarding (1) how this can be achieved logistically and (2) whether this policy is associated with a significant increase in procedural risks.
This is a prospective, consecutive study of delays to surgery and 30-day outcomes in recently symptomatic patients who underwent CEA between 1 October 2008 and 15 June 2010 after the creation of a rapid access TIA service.
A total of 109 symptomatic patients underwent CEA, 78% within 14 days of the index event and 90% within 14 days of referral. The median delay to surgery was 9 days from the index event and 4 days from referral. There were no perioperative deaths. Two strokes occurred (one intra-operative and one post-operative) to give a 30-day death/stroke rate of 1.83%. Patients undergoing CEA within 14 days of the index event incurred a death/stroke rate of 2.4% (2/84), increasing to 4.3% in patients undergoing surgery within 7 days (2/47).
Service reconfigurations can lead to significant reductions in delays to treatment in patients with symptomatic carotid disease. CEA can be performed in the hyperacute period without significantly increasing the operative risk.
在经历短暂性脑缺血发作（TIA）或小中风后，再次中风的最高风险发生在第 7-14 天。当代指南建议在此期间进行颈动脉内膜切除术（CEA），但存在以下两个问题：（1）如何在实际操作中实现这一点；（2）该政策是否会导致手术风险显著增加。
这是一项前瞻性、连续研究，研究对象为在 2008 年 10 月 1 日至 2010 年 6 月 15 日创建快速 TIA 服务后，最近出现症状并接受 CEA 的患者，研究内容为手术延迟及 30 天内的结果。
共有 109 名有症状的患者接受了 CEA 治疗，其中 78%在指数事件发生后 14 天内进行，90%在转诊后 14 天内进行。手术的中位数延迟时间为指数事件后 9 天，转诊后 4 天。无围手术期死亡。2 例患者发生中风（1 例术中，1 例术后），30 天死亡率/中风率为 1.83%。在指数事件发生后 14 天内接受 CEA 的患者死亡率/中风率为 2.4%（84 例中的 2 例），在 7 天内接受手术的患者死亡率/中风率增加到 4.3%（47 例中的 2 例）。
服务重组可以显著减少有症状颈动脉疾病患者的治疗延迟。在超急性期进行 CEA 不会显著增加手术风险。
