Bruls Samuel, Desfontaines Philippe, Defraigne Jean-Olivier, Sakalihasan Natzi
Department of Cardiovascular and Thoracic Surgery, University Hospital of Liege, Liege, Belgium;
Department of Neurology and Stroke Unit, CHC, Liege, Belgium; and.
Aorta (Stamford). 2013 Jul 1;1(2):110-6. doi: 10.12945/j.aorta.2013.13-008. eCollection 2013 Jul.
To evaluate the feasibility and the safety of performing urgent (within 24 hours) carotid endarterectomy in patients with carotid stenosis presenting with repetitive transient ischemic attacks or progressing stroke.
Thirty consecutive patients underwent urgent carotid endarterectomy for repetitive transient ischemic attacks (N = 12) or progressing stroke (N = 18) according to the following criteria: two or more transient ischemic attacks or a fluctuating neurological deficit over a period of less than 24 hours (progressing stroke), no impairment of consciousness, no cerebral infarct larger than 1.5 cm in diameter on computed tomography and a carotid artery stenosis of 70% or more on the appropriate side, diagnosed by echodoppler ultrasonography and/or arteriography. Patients with cerebral hemorrhage were excluded. All patients were examined pre- and postoperatively by the same neurologist and surgery was performed by the same vascular surgeon. All the patients underwent a cerebral CT scan within 5 days after surgery.
There were 19 men and 11 women. The mean age was 71 ± 7.6 years. The time delay of surgery after the onset of transient ischemic attacks or progressing stroke averaged 19.4 ± 11.5 hours. For patients suffering progressive stroke, one developed a fatal ischemic stroke 24 hours after surgery, five showed no improvement of their neurological status after surgery, but none worsened. Twelve patients experienced significant improvement of their neurological status with an European Stroke Scale of 77.9 ± 25.2 at admission and 95.8 ± 4.6 at discharge, and all but one of those patients had a Barthel's index value over 85/100 at discharge. The 12 patients with repetitive transient ischemic attacks had an uneventful postoperative outcome. The mean duration of follow-up was 3.4 ± 1.2 years. No patient developed another transient ischemic attack or ischemic stroke during the follow-up period.
The results of our series documented the feasibility and the safety of performing urgent (within 24 hours) carotid endarterectomy in patients presenting with repetitive transient ischemic attacks or progressing stroke. This procedure seems to us to be justified by the fact that waiting for surgery may lead to the development of a more profound deficit or another stroke in these neurologically unstable patients whose only chance for neurological recovery is in the early phase.
评估对伴有反复短暂性脑缺血发作或进展性卒中的颈动脉狭窄患者进行紧急（24小时内）颈动脉内膜切除术的可行性和安全性。
30例连续患者因反复短暂性脑缺血发作（n = 12）或进展性卒中（n = 18）接受紧急颈动脉内膜切除术，符合以下标准：两次或更多次短暂性脑缺血发作或在不到24小时的时间段内神经功能缺损波动（进展性卒中），意识无损害，计算机断层扫描显示直径大于1.5 cm的脑梗死，经超声多普勒检查和/或动脉造影诊断患侧颈动脉狭窄70%或更高。排除脑出血患者。所有患者术前和术后均由同一位神经科医生检查，手术由同一位血管外科医生进行。所有患者术后5天内均接受脑部CT扫描。
男性19例，女性11例。平均年龄为71±7.6岁。短暂性脑缺血发作或进展性卒中发作后至手术的时间延迟平均为19.4±11.5小时。对于进展性卒中患者，1例术后24小时发生致命性缺血性卒中，5例术后神经功能无改善，但无一例恶化。12例患者神经功能显著改善，入院时欧洲卒中量表评分为77.9±25.2，出院时为95.8±4.6，除1例患者外，所有患者出院时巴氏指数值均超过85/100。12例反复短暂性脑缺血发作患者术后恢复顺利。平均随访时间为3.4±1.2年。随访期间无患者发生另一次短暂性脑缺血发作或缺血性卒中。
我们系列研究的结果证明，对伴有反复短暂性脑缺血发作或进展性卒中的患者进行紧急（24小时内）颈动脉内膜切除术是可行和安全的。在我们看来，对于这些神经功能不稳定的患者，等待手术可能会导致更严重的神经功能缺损或另一次卒中，而他们神经功能恢复的唯一机会在于早期阶段，因此这一手术似乎是合理的。
