Examination of efficacy and safety of 5 consecutive cases of emergency CEA and emergency CAS experienced at this facility

Abstract

  CEA and CAS in the acute phase of cerebral infarction are not well‒founded in the stroke treatment guidelines 2021. This time, we examined the efficacy and safety of the recent emergency CEA and CAS performed at our facility. From June 2018 to April 2020, there were 5 consecutive cases in which CEA or CAS was urgently performed on the day of onset or the next day, 3 of which were emergency CAS on the day of onset, 1 was emergency CEA on the day after onset, 1 An example was an emergency CAS the day after the onset. The age ranged from 47 to 89 years, with an average of 77.0 years, and all 5 cases were male. Regarding internal carotid artery stenosis in the neck, all 5 cases were severely stenotic, and 3 cases were pseudo‒occlusion. In addition, 3 of 5 cases had a known progression of stenotic lesions. In the pathology of the CEA case, intimal plaque presents with findings such as intrinsic breakdown, lipid richness, and thrombosis due to secondary aggregation, suggesting instability and disease progression, suggesting the adequacy of emergency treatment. Revascularization was successful in all 5 cases, and all were discharged with mRS 0‒1 on the 8th to 20th postoperative days. Emergency CEA or emergency CAS performed before the severity of cerebral infarction in advanced stroke or in patients with suspected progressive stroke was a relatively safe and effective revascularization method. However, sufficient attention must be paid to unstable plaques, postoperative hyperperfusion, and hemorrhagic cerebral infarction, and the decision to intervenion is an issue that requires further investigation.