Abstract Details

Title Emergent Carotid Endarterectomy Is Associated with Good 3-month Clinical Outcomes and Low 3-month Mortality in Patients with Acute Ischemic Stroke and Acute Cervical Internal Carotid Artery Occlusion

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P12 - Poster Session 12 (11:45 AM-12:45 PM)

Poster/Presentation
Number 13-005

Objective

To assess the safety and efficacy of intravenous thrombolysis (IVT), emergent carotid endarterectomy (CEA), and IVT+CEA in patients with acute ischemic stroke and acute cervical internal carotid artery (ICA) occlusion.

Background

Acute ischemic stroke in acute cervical ICA occlusion is often associated with a severe and persistent neurological deficit and a high mortality rate. IVT is the only standard treatment method. An emergent CEA used alone or in combination with IVT represents an experimental alternative.

Design/Methods In a retrospective, multicentre study, the IVT group consisted of 41 patients (26 males; median age 72 [60–79] years), the IVT+CEA group of 31 patients (26 males; median age 70 [63–77] years), and the CEA group of 61 patients (45 males; median age 68 [61–75] years). Neurological deficit was assessed using the National Institutes of Health Stroke Scale (NIHSS) on admission and after 24 h and 3-month modified Rankin Scale (mRS – with good clinical outcome defined as mRS 0–3). Logistic regression analysis was used to identify independent predictors of the achievement of good 3-month clinical outcomes and 3-month mortality.

Results The following results were observed in the IVT, IVT+CEA, and CEA groups: recanalization rate 17.1%, 77.4%, and 88.5%, resp.; good 3-month clinical outcomes in 56.1%, 74.2%, and 89.8%, resp.; 3-month mortality in 22.0%, 19.4%, and 6.8%, resp. (p<0.05 in all cases for IVT vs. CEA comparison). The use of CEA alone was identified as an independent positive predictor of the achievement of good 3-month clinical outcomes (OR 5.185, 95% CI: 1.973–13.63; p=0.0009), and an independent negative predictor of 3-month mortality (OR 0.295, 95% CI: 0.07112–0.8754; p=0.0329).

Conclusions

In this retrospective, multicentre study, using an emergent CEA alone in patients with acute ischemic stroke and acute cervical ICA occlusion was associated with a higher recanalization rate and the achievement of good 3-month clinical outcomes and low 3-month mortality.

Authors/Disclosures
Roman Herzig, MD, PhD (Palacky University, Faculty of Medicine and Dentistry) PRESENTER	Roman Herzig, MD, PhD has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for AstraZeneca. Roman Herzig, MD, PhD has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Boehringer Ingelheim . Roman Herzig, MD, PhD has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Care Comm.
Igor Gunka, MD, PhD	Dr. Gunka has nothing to disclose.
Svatopluk Ostry, MD, PhD	Dr. Ostry has nothing to disclose.
Jiri Fiedler, MD, PhD	Dr. Fiedler has nothing to disclose.
Vladimir Priban, MD, PhD	Dr. Priban has nothing to disclose.
Martin Kovar, MD	The institution of Dr. Kovar has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for PHRI. Dr. Kovar has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for AstraZeneca. Dr. Kovar has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Novo Nordisk. Dr. Kovar has received research support from StroCzech Research Network.
Petr Stadler, MD, PhD	Prof. Stadler has received publishing royalties from a publication relating to health care.
Ondrej Skoda, MD (Neurologicka klinika Jihlava)	Ondrej Skoda, MD has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TEVA. Ondrej Skoda, MD has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Boehringer Ingelheim. Ondrej Skoda, MD has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Ondrej Skoda, MD has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novo Nordisk. Ondrej Skoda, MD has received personal compensation in the range of $500-$4,999 for serving as a Consultant for AstraZeneca. Ondrej Skoda, MD has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Ondrej Skoda, MD has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Ondrej Skoda, MD has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ipsen. Ondrej Skoda, MD has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Janssen. Ondrej Skoda, MD has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Meditorial.
Jiri J. Neumann, MD, FESO	Mr. Neumann has received personal compensation for serving as an employee of Boehringer Ingelheim. Mr. Neumann has received personal compensation for serving as an employee of Teva. Mr. Neumann has received personal compensation for serving as an employee of Novartis. Mr. Neumann has received personal compensation for serving as an employee of Pfizer.
Veronika Kunesova, PhD	Dr. Kunesova has nothing to disclose.

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