Stroke recurrence within the time window recommended for carotid endarterectomy

Area of Science:

• Neurology
• Vascular Medicine
• Epidemiology

Background:

• Recurrent stroke poses a significant risk to patient outcomes.
• Carotid stenosis (CS) is a known risk factor for ischemic stroke.
• The optimal timing for intervention in symptomatic CS remains a critical clinical question.

Purpose of the Study:

• To investigate the risk of recurrent stroke in patients with symptomatic carotid stenosis (CS) within the 14-day window relevant for endarterectomy.
• To identify predictors of early recurrent stroke in a population-based cohort.

Main Methods:

• A prospective, population-based cohort study identified ischemic stroke patients over one year.
• Patients were categorized based on the presence (CS-positive) or absence (CS-negative) of ipsilateral carotid stenosis (≥50% lumen narrowing).
• Stroke recurrence was assessed at 72 hours, 7 days, and 14 days post-symptom onset.

Main Results:

• Of 314 analyzed patients, 36 had CS-positive and 278 had CS-negative.
• Recurrent stroke rates were significantly higher in CS-positive patients at 72 hours (5.6% vs 0.4%, p=0.003), 7 days (5.6% vs 0.7%, p=0.01), and 14 days (8.3% vs 1.8%, p=0.02).
• CS was an independent predictor of recurrence at 72 hours (aHR 36.1) and 7 days (aHR 9.1), with a trend at 14 days (aHR 4.6).

Conclusions:

• Symptomatic carotid stenosis is associated with a high risk of early recurrent stroke, particularly within the first 72 hours.
• The findings support the need for timely intervention in high-risk CS patients.
• Earlier carotid revascularization or optimized acute medical management may mitigate recurrent stroke events.