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De ratione temporis

Einfluss der Zeit zwischen Ischämie und Operation auf die Komplikationsrate bei Thrombendarteriektomie symptomatischer Karotisstenosen

De ratione temporis

Influence of time between ischemia and surgery on the complication rate in carotid endarterectomy for symptomatic carotid artery stenosis

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Zusammenfassung

Zielsetzung

Die frühe Thrombendarteriektomie (TEA) einer symptomatischen Karotisstenose mit prophylaktischem Nutzen ist belegt, eine Operation innerhalb von 14 Tagen wird empfohlen. Noch kürzere Zeiträume (<48 h) würden das Risiko eines Rezidiv-Schlaganfalls reduzieren, könnten anhand neuer Untersuchungen aber mit einem erhöhten Komplikationsrisiko assoziiert sein. Ziel der vorliegenden Arbeit ist die Ermittlung der Komplikationsrate einer sehr frühen, d. h. innerhalb von 48 h durchgeführten TEA. Variablen, die mit diesem Operationsrisiko assoziiert sind und deren Modifizierung mit einer Senkung dieses Risikos einhergehen könnte, sollen identifiziert werden.

Methodik

459 Patienten mit symptomatischer Karotisstenose (okuläre oder zerebrale TIA) wurden untersucht. Die Auswertung erfolgte für die Zeitintervalle bis TEA 0–2 Tage, 3–14 Tage und 15–180 Tage. Outcome war ein persistierender (>7 Tage) ischämischer Schlaganfall oder der Tod innerhalb von 30 Tagen postoperativ.

Ergebnisse

44 (9,6 %) Patienten wurden innerhalb von 2 Tagen operiert. 25 (7,4 %) Patienten erlitten perioperativ einen persistierenden Schlaganfall oder starben, davon 3 (6,8 %) bei TEA innerhalb von 0–2 Tagen, 10 (6,8 %) von 3–14 Tage und 12 (4,5 %) von 15–180 Tage. Damit fand sich kein signifikanter Zusammenhang der Komplikationsrate mit dem Zeitintervall. Von allen Variablen war allein eine intensivierte Thrombozytenaggregationshemmung (TAH) mit einer sehr frühen TEA assoziiert.

Diskussion

Im Gegensatz zu bisherigen Untersuchungen konnten wir kein erhöhtes Operationsrisiko für eine sehr frühe sekundärpräventive TEA einer symptomatischen Karotisstenose zeigen. Eine Ursache dafür könnte die intensivierte TAH sein, die zur Reduktion früh-perioperativ auftretender thrombembolischer Schlaganfälle führt.

Abstract

Objectives

Early carotid endarterectomy (CEA) is recommended for symptomatic carotid artery stenosis with preventive benefit, so it should be performed within 14 days. The risk of recurrent stroke can be reduced if very urgent surgery (<48 h) is performed, but can be—according to newer studies—accompanied by a significantly increased perioperative risk. The aim of this study is to analyze the perioperative outcome of very early CEA within 48 h. In particular we want to identify variables associated with a perioperative risk and provide some modifications to decrease any risk factors.

Methods

We retrospectively analyzed data of 459 symptomatic patients with ocular or cerebral TIA. Patients were divided according to time interval between onset of symptoms and surgery 0–2 days, 3–14 days, and 15–180 days. Outcome event was assessed a persisting stroke or death within 30 days after surgery.

Results

Very early CEA was performed in 44 (9.6 %) patients. Overall 25 patients (7.4 %) suffered any perioperative stroke or death, divided into subgroups 3 (6.8 %) by day 2, 10 (6.8 %) by day 14, and 12 (4.5 %) by day 180. We did not find any significance between a higher perioperative risk and timing of CEA. Solely an intensified antiplatelet therapy was associated with a very early CEA.

Conclusions

In contrast to recent registry analyses, our data show that very early prophylactic CEA in symptomatic patients can be performed without any increased procedural risk. More intensified antiplatelet therapy may be a reason for reduced thromboembolic strokes.

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Authors and Affiliations

  1. Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Fachbereich Gefäßchirurgie, Universitätsklinikum Magdeburg A.ö.R., Leipziger Str. 44, 39120, Magdeburg, Deutschland

    A. Rappe &  Z. Halloul

  2. Klinik für Neurologie, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, Deutschland

    M. Görtler

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  1. A. Rappe
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  2. M. Görtler
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  3. Z. Halloul
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Correspondence to A. Rappe.

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Interessenkonflikt

A. Rappe, M. Görtler und Z. Halloul geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Rappe, A., Görtler, M. & Halloul, Z. De ratione temporis. Gefässchirurgie 21, 495–502 (2016). https://doi.org/10.1007/s00772-016-0204-0

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  • DOI: https://doi.org/10.1007/s00772-016-0204-0

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