Faculty Opinions recommendation of Recurrent stroke in symptomatic carotid stenosis awaiting revascularization: A pooled analysis.

2016 ◽  
Author(s):  
Norman Hertzer
Keyword(s):  
Carotid Stenosis ◽  
Recurrent Stroke ◽  
Pooled Analysis ◽  
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.

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 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
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