Recurrent stroke in symptomatic carotid stenosis awaiting revascularization: A pooled analysis

Area of Science:

• Neurology
• Vascular Surgery
• Epidemiology

Background:

• Symptomatic carotid stenosis poses a significant risk of ischemic stroke.
• Current guidelines recommend revascularization within 14 days for eligible patients.

Purpose of the Study:

• To quantify the risk and identify predictors of ipsilateral ischemic stroke in patients with symptomatic carotid stenosis awaiting revascularization.
• To pool individual patient data from recent prospective studies with high rates of modern stroke prevention medications.

Main Methods:

• Pooled individual patient data from 2 prospective hospital-based registries and 1 prospective population-based study.
• Included patients with symptomatic 50%-99% carotid stenosis eligible for carotid revascularization.
• Followed patients for early recurrent ipsilateral stroke or retinal artery occlusion (RAO).

Main Results:

• Of 377 eligible patients, ipsilateral recurrent ischemic stroke/RAO risk was 11.5% at 14 days and 18.8% at 90 days.
• Older age (HR per 10-year increase 1.5) was associated with increased recurrence risk.
• A trend for higher risk was observed for cerebral versus ocular symptoms (adjusted HR 2.7).

Conclusions:

• High risk of recurrent ipsilateral ischemic events exists within 14 days, the current recommended timeframe for carotid endarterectomy (CEA).
• Randomized trials are needed to evaluate the benefits and safety of urgent versus subacute carotid revascularization within 14 days of symptom onset.