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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Timing of Carotid Revascularization Procedures After Ischemic Stroke
Michael Reznik1, Hooman Kamel1, Gino Gialdini1
1From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (M.R., H.K., G.G., B.B.N., A.G.) and Department of Neurology (M.R., H.K., B.B.N.), Weill Cornell Medicine, New York; Department of Neurology, Columbia College of Physicians and Surgeons, New York (M.R.); Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA (A.P.); and Department of Radiology, Weill Cornell Medicine, New York (A.G.).
Background And Purpose:
In 2006, the American Heart Association recommended that carotid revascularization generally occurs within 2 weeks of stroke based on data from 2 trials of carotid endarterectomy (CEA). We aimed to determine whether the time between stroke and CEA or carotid artery stenting (CAS) has decreased and whether the proportion of procedures occurring within 14 days has increased.
Methods:
Using validated International Classification of Diseases, Ninth Revision, Clinical Modification codes and administrative claims data from nonfederal hospitals in CA, FL, and NY, we identified patients with ischemic stroke who underwent CEA or CAS within 90 days of an ischemic stroke from 2005 to 2013. Our outcomes were the number of days between stroke and CEA/CAS and the proportion of patients undergoing CEA/CAS within the recommended 14-day period. We assessed temporal trends using nonparametric correlation, the χ2 test for trend, and logistic regression.
Results:
We identified 16 298 patients with ischemic stroke who underwent CEA/CAS within 90 days. The time from stroke to CEA/CAS decreased from 25 days (interquartile range, 5-48 days) in 2005 to 6 days (interquartile range, 3-17 days) in 2013 (P<0.001). The proportion of patients who underwent CEA/CAS within 14 days of stroke increased from 40% (95% confidence interval, 37%-43%) in 2005 to 73% (95% confidence interval, 71%-76%) in 2013 (P<0.001). These temporal trends remained significant after adjustment for patient demographics and comorbidities.
Conclusions:
Since 2005, revascularization for symptomatic carotid disease has been occurring progressively sooner after ischemic stroke.
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