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Updated: Dec 10, 2025
A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Impact of Time Interval between Index Event and Stenting on Periprocedural Risk in Patients with Symptomatic Carotid
Wonsuck Han1, Gyojun Hwang1, Sung Han Oh1
1Department of Neurosurgery, Bundang Jesaeng General Hospital, Seongnam, Korea.
Insights
Delaying carotid stenting beyond 7 days after symptom onset reduces clinical event risk for symptomatic carotid stenosis. Stenting within 7 days carries a higher risk, while later stenting shows comparable safety to asymptomatic cases. Radiological event risk remains unaffected by timing.
Area of Science:
- Interventional Cardiology
- Neurology
- Vascular Surgery
Background:
- Carotid stenosis poses a significant risk for stroke.
- Carotid stenting is a treatment option for symptomatic carotid stenosis.
- The optimal timing for carotid stenting after an index event is debated.
Purpose of the Study:
- To evaluate the impact of the time interval between index event and stenting on periprocedural risk.
- To determine the optimal timing for stenting in symptomatic carotid stenosis.
Main Methods:
- Retrospective study of 491 patients undergoing carotid stenting (322 symptomatic, 169 asymptomatic).
- Symptomatic patients grouped by time interval (0-3, 4-7, 8-10, 11-14, 15-21, >21 days) from index event to stenting.
- Logistic regression analysis used to calculate periprocedural clinical and radiological event risks, adjusted for confounders.
Main Results:
- Overall clinical event rate was higher in symptomatic (4.3%) vs. asymptomatic (1.2%) stenosis.
- Stenting within 7 days (Day 0-3 and 4-7) showed significantly higher clinical event risks.
- Clinical event rates after 7 days were comparable to asymptomatic stenosis; radiological event risk was consistently high across all time intervals.
Conclusions:
- Delayed stenting (after 7 days) significantly decreases periprocedural clinical event risk in symptomatic carotid stenosis.
- Stenting within 7 days of symptom onset is associated with elevated clinical event risk.
- Delayed stenting after 7 days is a safe strategy, with clinical event rates similar to asymptomatic stenosis.
Objective:
The purpose of this study was to evaluate the impact of time interval between index event and stenting on the periprocedural risk of stenting for symptomatic carotid stenosis and to determine the optimal timing of stenting.
Methods:
This retrospective study included 491 (322 symptomatic [65.6%] and 169 asymptomatic [34.4%]) patients undergoing carotid stenting. The symptomatic patients were categorized into Day 0-3, 4-7, 8-10, 11-14, 15-21, and >21 groups according to the time interval between index event and stenting. Periprocedural (≤30 days) risk for clinical (any neurological deterioration) and radiological (new infarction on postprocedural diffusion-weighted imaging) events of stenting in each time interval versus asymptomatic stenosis was calculated with logistic regression analysis adjusted for confounders, and provided as odds ratio (OR) and 95% confidence interval (CI).
Results:
Overall clinical event rate (4.3%) of stenting for symptomatic carotid stenosis was higher than that for asymptomatic stenosis (1.2%; OR, 3.979 [95% CI, 1.093-14.489]; p=0.036). Stenting in Day 0-3 (13.2%; OR, 10.997 [95% CI, 2.333-51.826]; p=0.002) and Day 4-7 (8.3%; OR, 6.775 [95% CI, 1.382-33.227]; p=0.018) was associated with high risk for clinical events. However, the clinical event rates in stenting after 7 days from index event (Day 8-10, 1.8%; Day 11-14, 2.5%; Day 15-21, 0%; Day >21, 2.9%) were not different from that in stenting for asymptomatic stenosis. Overall radiological event rate (55.6%) in symptomatic stenosis was also higher than that in asymptomatic stenosis (35.5%; OR, 2.274 [95% CI, 1.553-3.352]; p<0.001). The high risk for radiological events was maintained in all time intervals (Day 0-3 : 55.3%; OR, 2.224 [95% CI, 1.103-4.627]; p=0.026; Day 4-7 : 58.3%; OR, 2.543 [95% CI, 1.329-4.949]; p=0.005; Day 8-10 : 53.6%; OR, 2.096 [95% CI, 1.138-3.889]; p=0.018; Day 11-14 : 57.5%; OR, 2.458 [95% CI, 1.225-5.021]; p=0.012; Day 15-21 : 55.6%; OR, 2.271 [95% CI, 1.099-4.764]; p=0.028; Day >21 : 54.8%; OR, 2.203 [95% CI, 1.342-3.641]; p=0.002).
Conclusion:
This study showed that as stenting was delayed, the periprocedural risk for clinical events decreased. The clinical event risk was high only in stenting within 7 days and comparable with that for asymptomatic stenosis in stenting after 7 days from index event, although the radiological event risk was not affected by stenting timing. Therefore, our results suggest that delayed stenting after 7 days from symptom onset is a safe strategy for symptomatic stenosis.
