Risk of recurrent stroke before carotid endarterectomy: the ANSYSCAP study
E P Johansson1, C Arnerlöv, P Wester
1Department of Public Health and Clinical Medicine, Umeå Stroke Centre, Umeå University, Umeå, Sweden. elias.johansson@medicin.umu.se
Summary
Urgent carotid endarterectomy is crucial for reducing stroke risk. Performing this surgery within days of symptoms significantly lowers the chance of recurrent ischemic stroke.
Area of Science:
- Vascular Surgery
- Neurology
- Stroke Prevention
Background:
- Carotid endarterectomy (CEA) reduces stroke risk, with greater benefit when performed within two weeks of symptoms.
- Earlier CEA intervention may offer additional risk reduction benefits.
Purpose of the Study:
- To evaluate the 90-day risk of ipsilateral ischemic stroke recurrence in patients with symptomatic 50-99% carotid stenosis.
- Emphasis was placed on the critical first 14 days post-event.
Main Methods:
- Prospective cohort study of 230 patients with symptomatic carotid stenosis.
- 183 patients underwent CEA, with a median delay of 29 days.
- High medication adherence for blood pressure (93%) and lipids (90%).
Main Results:
- The cumulative risk of ipsilateral ischemic stroke recurrence was 5.2% within 2 days, 7.9% within 7 days, 11.2% within 14 days, and 18.6% within 90 days.
- Stroke or transient ischemic attack (TIA) as the presenting event significantly increased recurrence risk compared to amaurosis fugax.
Conclusions:
- High risk of recurrent ipsilateral ischemic stroke observed in the initial days following a cerebrovascular event.
- Performing CEA earlier, within the first few days, could potentially prevent numerous stroke recurrences.
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