Safety of early carotid endarterectomy

Carotid endarterectomy is indicated in patients with symptomatic stenosis of internal carotid arteries above 50%. The aim of the study was to determine safe time span between neurological symptoms and surgery, and to compare how different periods have changed the rates of complications in three groups of patients.
Patients were divided by period between neurological symptoms and surgery in three groups: first group consisted of patients operated up to 14 days from symptoms, second from day 15 to day 30, and third group consisted of patients operated more than 30 days from neurological symptomatology. All patients underwent surgery at our department from January 2015 to December 2018.
Totally 316 patients were operated at our department during the last four years. Major postoperative complications (stroke, death or myocardial infarct) occurred in 8 patients (2.5%).
From the first group, 3 patients suffered postoperative stroke or death (2.36%), in the second group 2 patients (2.2%), and 2 patients (2.04%) in the third group of patients. The difference between the groups was not significant.
Most recurrent strokes occur within two weeks since primary stroke. Timing of carotid endarterectomy overcame several historical stages because of postoperative complications. Safe period for
the best benefit of patients had to be found. At our department, we perform carotid endarterectomy within 14 days from symptoms, if the ischemic lesion in the brain is smaller than 2×3cm.
Carotid endarterectomy can be safely performed after the primary stroke, without significant difference in postoperative complications in different groups. The best timing of surgery to prevent recurrent stroke is within two weeks since primary stroke.