Symptomatic Carotid Arteries: Early or Late Emergency Revascularization?

Carotid endarterectomy continues to be the safest technique for emergency revascularization. However, 48 hours after index event, different strategy outcomes will become comparable. 

Carótidas sintomáticas: ¿revascularización urgente, precoz o retardada?

Multiple advances in device development have brought promising results for carotid revascularization patients with symptomatic stenosis. Regardless these developments, optimal revascularization timing after index event remains unclear

This study included patients with symptomatic carotid stenosis undergoing transcarotid artery revascularization (TCAR), transfemoral carotid stenting (TFCAS), or carotid endarterectomy (CEA) at different times after index event. 

Procedures were regarded as urgent (0 to 2 days after last event), early (3 to 14 days) or late (15 to 180 days).

Primary end point was inhospital death or stroke. Secondary end point added transient ischemic event. 

The study included 18,643 symptomatic revascularizations: 10.8% were urgent, 39.8% were early, and the remaining half was late.

Read also:  TICO: Age Impacts the Effect of Antiplatelet Monotherapy.

Patients undergoing TFCAS showed the highest rate of stroke and death at all timing cohorts. 

Among urgent cases, CAE had 4% events vs 6.9% for TFCAS and 6.5% for TCAR (p=0.018). These differences tended to level off the later patients were treated. 

When adjusting for risk, OR resulted similar between patients undergoing CAE and TCAR. 


CAE continues to be the safest revascularization approach for emergency cases. TCAR and CAE seem similar after 48 hours. 

Original Title: In-Hospital Outcomes of Urgent, Early, or Late Revascularization for Symptomatic Carotid Artery Stenosis.

Reference: Christina L. Cui et al. J Am Heart Assoc. 2021 Dec 21;10(24):e022700. doi: 10.1161/JAHA.121.022700.

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