Background
The aim of this study is to evaluate the role of preoperative ischemic brain lesion
(IBL) volume, assessed by Diffusion-weighted magnetic resonance brain imaging (DW-MRI)
with RAPID® processing, and surgery timing in predicting post-operative neurological
outcomes in symptomatic carotid stenosis (SCS) patients treated with carotid endarterectomy
(CEA).
Materials and Methods
All patients with SCS who underwent CEA between January 2010 and June 2020 were considered.
IBLs ipsilateral to the stenosis were identified in the preoperative magnetic resonance
brain (MRI). The volume was quantified in mL and correlated with 30-day rates of stroke
and stroke/death by χ2 and receiver operating characteristic (ROC) curve.
Results
One hundred thirty-four patients were surgically treated for SCS during the entire
study period. CEA procedures were defined as emergent, urgent, or elective if performed
within 48 hr, between 48 hr and 14 days, or after 14 days from symptoms onset, respectively.
Cumulative new ipsilateral stroke rate was 4,5%, with a statistically higher neurological
complications in emergent patients compared to urgent and elective patients (10,6%,
1,47% and 0% respectively, P 0,039). ROC curve analysis showed a volume of 10 mL was predictive of postoperative
stroke with 100% sensitivity and 80% specificity. An IBL volume >10 mL was an independent
risk factor for postoperative stroke. In fact, the perioperative neurological complication
rate was significantly different in high-IBL volume patients (>10 mL) compared with
low-IBL volume patients (<10 mL) (P 0,003)
Conclusions
The present study suggests that the optimal timing for CEA is between 48 hr and 14
days. Furthermore, the present study suggests that the presence of the IBL, by itself,
is not definitively related with an unsatisfactory neurological outcome. However,
an IBL higher than 10 mL should be as a reliable threshold value adverse neurological
result in SCS patients
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Article Info
Publication History
Published online: December 22, 2021
Accepted:
December 4,
2021
Received in revised form:
November 29,
2021
Received:
July 28,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
