To evaluate the impact of timing on perioperative and clinical outcomes in patients undergoing carotid endarterectomy (CEA) or carotid artery stenting (CAS) for symptomatic carotid stenosis. This retrospective cohort study included 400 patients treated with carotid revascularization at a single center from October 2020 to October 2024. Patients were stratified into four timing groups: very early (0–7 days), early (8–14 days), moderately delayed (15–21 days), and delayed (>21 days) after symptom onset. Periprocedural and long-term outcomes, including stroke, mortality, restenosis, and recurrent ischemic events, were assessed and compared between CEA and CAS groups. Periprocedural stroke rates were highest in the very early group (5.0% for CEA vs. 6.6% for CAS, p=0.192) and lowest in the early group (1.7% for CEA vs. 4.0% for CAS, p=0.041). Periprocedural mortality decreased progressively across timing groups, with the delayed group showing the lowest rates (1.4% for CEA vs. 0.0% for CAS, p=0.353). At six months, restenosis rates and recurrent stroke rates were comparable between CEA and CAS across all timing groups. Complications, including bleeding and cardiac events, were more frequent in the very early group and declined with delayed interventions. Timely carotid revascularization within 14 days of symptom onset can reduce the risk of recurrent strokes while maintaining acceptable perioperative safety. However, individualized patient selection based on clinical factors and procedural risks remains critical. Further prospective studies are needed to establish optimal timing thresholds and refine strategies for both early and delayed revascularization.
Key words: Carotid endarterectomy; carotid artery stenting, timing, symptomatic carotid stenosis, perioperative outcomes
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