Relationship between surgical timing and clinical outcomes of carotid endarterectomy for symptomatic carotid stenosis

Objective To explore the clinical outcomes of carotid endarterectomy (CEA) on patients with symptomatic carotid stenosis and its correlation with the timing of surgery. Methods A retrospective analysis was conducted on the clinical data of 146 patients with symptomatic carotid stenosis treated with CEA at Neurosurgery Department of the First Affiliated Hospital of Soochow University from September 2012 to May 2018. All 146 patients were divided into group A (≤14 d, 57 cases) and group B (> 14 d, 89 cases) according to the time from the initial symptoms to CEA. All patients underwent CT computed tomography perfusion (CTP) and transcranial doppler (TCD), and stroke patients were evaluated by the National Institutes of Health stroke scale (NIHSS) at 5 days after surgery. All patients were followed up on an outpatient basis 12 months after discharge, including re-examination of CTP and TCD, NIHSS scores for stroke patients, and observation of surgical-side restenosis. Results Perioperative stroke occurred in 1 (0.7%) of the 146 patients. Compared with preoperative 5 days after surgery, cerebral blood flow and cerebral blood volume were increased, and mean transit time (MTT) and time to peak (TTP) were shortened in the basal ganglia and temporal lobe of 146 patients (all P 0.05). Six patients (4.1%, 6/146) had restenosis on the surgical side. There were no significant differences in age, gender, medical history, smoking history, onset symptoms, or degree of carotid stenosis between the two groups of patients (all P>0.05). The change rate of MVMCA in group A was higher than that in group B at 5 days and 12 months after operation [5 days after operation: 41.0(16.7, 78.1)%, 18.9(4.9, 44.3)%, 12 months after operation: 40.5(13.0, 76.6)%, 15.9(7.2, 38.1)%, both P<0.05]. The rate of change in NIHSS scores of stroke patients in group A was greater than that in group B [5 days after operation: -100.0(-100.0, -60.0)%, -66.7(-100.0, -50.0)%, 12 months after operation: -100.0(-100.0, -58.6)%, -50.0(-100.0, -33.3)%, both P<0.05]. Conclusions Carotid endarterectomy could significantly improve cerebral perfusion, cerebral hemodynamics, and some neurological functions in patients with symptomatic carotid stenosis, and the early surgical prognosis seems better. Key words: Carotid stenosis; Treatment outcome; Carotid endarterectomy; Surgical timing