Urgent carotid endarterectomy within the first 24 hours of the acute stroke period

Introduction. Acute cerebrovascular accident (stroke) is one of the primary causes of disability in the Russian Federation and worldwide. Approximately one-quarter of strokes are recurrent, with a higher likelihood of leading to disability and mortality. One method of surgical prevention for recurrent cerebrovascular accidents is carotid endarterectomy (CEA). For symptomatic stenosis of the internal carotid artery, surgical intervention should be performed within 14 days of the onset of acute stroke [1]. Currently, the necessity and safety of performing emergency CEA within the first 24 hours of stroke onset, especially in combination with thrombolytic therapy and/or thrombectomy, remains a debated issue. Clear criteria for selecting patients for surgical intervention have not been established. Materials and methods. The study included 39 patients with ischemic stroke who were admitted to the KBC named after S.P. Botkin on the first day of their stroke and underwent carotid endarterectomy. All patients underwent neurological status evaluation using the NIHSS (National Institutes of Health Stroke Scale), modified Rankin Scale, modified Rivermead Mobility Index, brain CT, CT angiography, CT perfusion, duplex ultrasound scanning (DUS) of the brachiocephalic arteries, and lipid profile analysis. Results. Hemorrhagic transformation of the stroke focus was observed in 5 (12.8%) patients; all patients with hemorrhagic transformation underwent reperfusion therapy – thrombolysis and/or thrombectomy. Upon admission, the severity of the stroke according to the NIHSS was 8.2±0.9 points, and at discharge, it was 5.4±0.8 points, p<0.05. The mobility index according to the Rivermead Scale at discharge was 8.6±0.8 points, and the degree of disability according to the Rankin Scale at discharge was 2.7±0.2 points. Among patients who underwent CEA within the first day of ischemic stroke, the mortality rate was 12.8% (n=5). Two clinical cases are presented, demonstrating successful carotid endarterectomy in the first day of stroke in combination with reperfusion therapy. Conclusion. Carotid endarterectomy within the first day of ischemic stroke may be considered not only as a method for preventing recurrent ischemic stroke but also as a treatment method that reduces the degree of patient disability. Further studies are required to develop a patient selection algorithm for CEA within the first day of acute cerebrovascular accident (CVA) to improve the effectiveness of surgical treatment and minimize postoperative complications.