scholarly journals Risk of Early Recurrent Stroke in Symptomatic Carotid Stenosis

2015 ◽  
Vol 61 (2) ◽  
pp. 570
Author(s):  
S. Strömberg ◽  
A. Nordanstig ◽  
T. Bentzel ◽  
K. Österberg ◽  
G.M.L. Bergström
Keyword(s):  
Carotid Stenosis ◽  
Recurrent Stroke ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis

Abstract TP135: Urgent Treatment for Symptomatic Carotid Stenosis: The Pittsburgh Revascularization and Treatment Emergently After Stroke Protocol

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Daniel Tonetti ◽  
Brian Jankowitz ◽  
Kenmuir Cynthia ◽  
Benjamin Zussman ◽  
Rahul Rao ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Primary Outcome ◽  
Recurrent Stroke ◽  
Carotid Stenting ◽  
Clinical Equipoise ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Recorded Data ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background: Patients with symptomatic carotid stenosis remain at high risk of early recurrent stroke without revascularization. The aim of this report is to analyze prospectively-recorded data from an institutional protocol that standardized the urgent (<48 hours) treatment of patients presenting with symptomatic carotid stenosis and underwent either carotid stenting (CAS) or carotid endarterectomy (CEA). Methods: All patients presenting over 28 months to a comprehensive stroke center with symptomatic carotid stenosis within 48 hours of index event were screened for inclusion. All patients were given dual antiplatelet therapy. If there was clinical equipoise between CEA and CAS, patients underwent angiography and subsequently revascularization if DSA demonstrated ≥50% stenosis. The primary outcome was a composite of stroke or death within 30 days. Results: 178 patients with a diagnosis of recently symptomatic carotid stenosis were included; 120 patients (67%) met criteria. 59 patients underwent CEA and 61 patients underwent CAS. There were not significant differences in the primary outcome; 3 patients (5.1%) in the CEA arm and 3 patients (4.9%) in the CAS arm met the primary outcome. Conclusion: In this prospective analysis, urgent revascularization for symptomatic carotid stenosis can be done with equivalently low rates of stroke or death, regardless of revascularization strategy.

Obstructed Flow

2016 ◽  
Author(s):  
Ji Y. Chong ◽  
Michael P. Lerario
Keyword(s):  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Transient Ischemic Attack ◽  
Recurrent Stroke ◽  
Early Period ◽  
Carotid Stenting ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Ischemic Attack

Patients with symptomatic carotid stenosis benefit from revascularization. The risk of recurrent stroke is highest during the early period after a transient ischemic attack or stroke. Carotid endarterectomy and carotid stenting are options for treatment and should be considered within the first 2 weeks if feasible.

scholarly journals Risk of Early Recurrent Stroke in Symptomatic Carotid Stenosis

2015 ◽  
Vol 49 (2) ◽  
pp. 137-144 ◽  
Author(s):  
S. Strömberg ◽  
A. Nordanstig ◽  
T. Bentzel ◽  
K. Österberg ◽  
G.M.L. Bergström
Keyword(s):  
Carotid Stenosis ◽  
Recurrent Stroke ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis

Abstract 84: Low Risk of Stroke or Death Among Patients With Recently Symptomatic Carotid Stenosis Awaiting Revascularisation - A Pooled Analysis of Randomised Trials

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Leo H Bonati ◽  
Stefanie von Felten ◽  
Gary S Roubin ◽  
Willem P Mali ◽  
Olav Jansen ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Median Time ◽  
Historical Data ◽  
Recurrent Stroke ◽  
Pooled Analysis ◽  
Symptomatic Carotid ◽  
Kaplan Meier ◽  
Symptomatic Carotid Stenosis ◽  
Patients At Risk ◽  
Severe Degree

Background: Historical data suggest that patients with recently symptomatic carotid stenosis are at high risk of early recurrent stroke. Guidelines therefore recommend revascularization within 2 weeks of symptoms. We assessed the risk of stroke or death occurring before revascularization in modern trials of symptomatic carotid stenosis. Methods: We pooled data of all individual patients with symptomatic carotid stenosis randomised to stenting (CAS) or endarterectomy (CEA) in the EVA-3S, SPACE, ICSS and CREST trials. The outcome event (OE) was death or any stroke occurring between randomization and treatment by CAS or CEA, or up to 120 days after randomization among patients not undergoing treatment in this period. Results: 4707 patients were included in the analysis. Median time from qualifying event until randomization was 18 (interquartile range 7-50) days. Median time from randomization until treatment was 6 (2-11) days in the CAS group, and 7 (3-12) days in the CEA group (p<0.001). 31% of patients in the CAS group and 27% in the CEA group underwent revascularization within 14 days of the qualifying event. The OE occurred in 21 patients (CAS: 8, CEA: 13), all within 31 days of randomization (Kaplan Meier estimate: 2.4%, standard error 0.7%; fig.), including 18 non-fatal strokes, 1 fatal stroke, and 2 non-stroke related deaths. In 2 of the patients, the date of the qualifying event was unknown, in 8 patients the OE occurred within 14 days of the qualifying event and in 11 patients >14 days after the qualifying event. All patients with the OE had severe (70-99% degree) stenosis. No other baseline variables predicted the OE. Discussion: Despite the fact that less than a third of patients underwent revascularization within 14 days of the qualifying event, only 2.4% of patients had a recurrent stroke or died before treatment. The risk is lower than expected from historical data, which may reflect advances in medical therapy. Patients at risk are those with severe degree of stenosis.

Recurrent stroke in symptomatic carotid stenosis awaiting revascularization

Neurology ◽  
2016 ◽  
Vol 86 (6) ◽  
pp. 498-504 ◽  
Author(s):  
Elias Johansson ◽  
Elisa Cuadrado-Godia ◽  
Derek Hayden ◽  
Jakob Bjellerup ◽  
Angel Ois ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Recurrent Stroke ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis

scholarly journals Carotid artery stenosis, an underestimated cause of stroke recurrence in patients with ischaemic monocular visual loss

2019 ◽  
Vol 101 (8) ◽  
pp. 579-583
Author(s):  
SF Cheng ◽  
A Zarkali ◽  
T Richards ◽  
R Simister ◽  
A Chandratheva
Keyword(s):  
Carotid Stenosis ◽  
Transient Ischaemic Attack ◽  
Visual Loss ◽  
Surgical Intervention ◽  
Recurrent Stroke ◽  
Stroke Recurrence ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Ischaemic Attack ◽  
Transient Visual Loss

Introduction Isolated monocular ischaemic events are thought to be low risk for stroke recurrence. In the presence of carotid stenosis however, the risks should not be treated similarly and surgical intervention should be considered at an early stage. The aim of this study was to determine the vascular risk profile and stroke recurrence in patients with ischaemic monocular visual loss. Methods and methods Consecutive records for all patients with monocular ischaemia were reviewed from January 2014 to October 2016. Stroke, transient ischaemic attack or monocular ischaemia recurrence within 90 days were recorded. Carotid stenosis was assessed with duplex ultrasound, computed tomography or magnetic resonance angiography. Results In total, 400 patients presented with monocular ischaemia; 391 had carotid imaging (97.8%). Causality was symptomatic carotid stenosis ≥ 50% in 53 (13.6%), including carotid stenosis ≥ 70% in 31 (7.9%). Patients with permanent visual loss (n = 131) were more likely to have significant stenosis compared with patients with transient visual loss (n = 260), 19.8% compared with 10.4% (P = 0.012). Recurrent stroke, transient ischaemic attack or monocular ischaemia within 90 days after presentation occurred in three patients (5.7%) in the carotid stenosis group, compared to three (0.9%) who did not have stenosis (P = 0.035). Age, male sex and hypertension were associated with carotid stenosis but hypercholesterolaemia, diabetes and smoking were not. Conclusions Carotid stenosis ≥ 50% is present in patients with ocular ischaemia in approximately 20% of those with persistent visual loss and in 10% with transient visual loss. Those with carotid stenosis have a higher risk of stroke recurrence and should be considered urgent surgical intervention as other forms of stroke.

scholarly journals P.065 Physician Approaches to Anti-thrombotic Therapies for Acutely Symptomatic Carotid Stenosis: Insights from the Hot Carotid Qualitative Study

2021 ◽  
Vol 48 (s3) ◽  
pp. S37-S37
Author(s):  
B Beland ◽  
A Ganesh ◽  
G Jewett ◽  
DJ Campbell ◽  
M Varma ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Antiplatelet Therapy ◽  
Qualitative Content Analysis ◽  
Recurrent Stroke ◽  
Stroke Care ◽  
Plaque Morphology ◽  
Structured Interviews ◽  
Carotid Disease ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis

Background: Whereas the beneficial effect of antiplatelet therapy for recurrent stroke prevention is well-established, uncertainties remain regarding the optimal anti-thrombotic regimen for acutely symptomatic carotid stenosis (“hot carotid”), particularly as patients await revascularization. We sought to explore the approaches of stroke physicians to peri-procedural anti-thrombotic management of patients with “hot carotids”. Methods: We conducted semi-structured interviews regarding “hot carotid” management with purposive sampling of 20 stroke physicians from 14 centres in North America, Europe, Asia, and Australia. We identified key themes using conventional qualitative content analysis. Results: Important themes revealed from our discussion included limitations of existing clinical trial evidence, competing surgeon versus neurologist/internist preferences, and single vs dual antiplatelet therapy (DAPT) while awaiting revascularization. Areas of uncertainty included the management of stroke while on aspirin, implications of non-stenotic features of carotid disease (intraluminal thrombus, plaque morphology), the role of newer anti-platelet agents or anticoagulants, platelet aggregation testing, and how soon to start DAPT. Conclusions: Our qualitative analysis revealed themes that were important to stakeholders in stroke care. Teams designing international trials will have to accommodate identified variations in anti-thrombotic practice patterns and take into consideration areas of uncertainty, such as newer anti-thrombotic agents, and the implication of non-stenotic features of carotid disease.

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