Carotid endarterectomy in acute period of ischemic stroke

Objective: to evaluate the results of surgical treatment of patients with carotid artery pathology in the acute period of the disease and to clarify surgical tactics in this category of patients. Materials and methods: from 01.01.2016 to 31.12.2019, 222 patients with CAO pathology were operated on in the neurosurgical department of Bryansk City Hospital No. 1, and 282 carotid endarterectomies (CEE) were performed. In the acute period of cerebral blood flow disorder (CBFD) 114 patients underwent 114 CEEs. The above patients were divided into III groups. Group I included 43 patients with unilateral lesion of the internal carotid artery (ICA). Group II included 49 patients with bilateral lesion of the ICA. Group III included 22 patients with a combination of stenosis and contralateral occlusion of the ICA. The control group included 108 patients who underwent CEE outside the acute period of CBFD. The control group was divided into three subgroups, respectively: unilateral ICA lesions, bilateral ICA lesions, combination of stenosis and contralateral ICA occlusion. Results: in the studied groups good and excellent outcomes (GOS=4-5b, mRs=1-2b) were obtained in 98.25 % (N112) of patients, in one case the patient had ischemic type stroke due to thrombosis of the surgical artery, lethality was 0.9 % (N=1). In the control group good and excellent outcomes (GOS=4-5b, mRs=1-2b) were obtained in 96.3 % (N108) of patients, mortality was 3.7 % (N=4). When comparing the NIHSS, mRs, RMI outcomes of the studied groups with the corresponding subgroups of the control group, no statistically significant difference was revealed. No statistically significant difference was found when evaluating the outcomes according to NIHSS, mRs, RMI of patients operated in the acute period of CBFD in the first 14 days and from 15 to 28 days. Conclusion: Carotid endarterectomy should be performed in the first two weeks of ischemic-type stroke regardless of the lesion of the contralateral carotid artery.