Predictive Factors for Pre-operative Recurrence of Cerebrovascular Symptoms in Symptomatic Carotid Stenosis

Prediction of Stroke Recurrence: Knowledge is the Prophet's Best Qualification

“…2 The European Society for Vascular Surgery guidelines recommend endarterectomy "as soon as possible, preferably within 14 days of symptom onset". 3 The findings of the study by Eriksson et al 1 support the first part of the phrase (i.e., "as soon as possible"), although the risk of recurrent stroke should be carefully weighed against the procedural risks before any firm conclusion is reached.…”

“…Prediction of the risk of early recurrent stroke in symptomatic carotid stenoses has received considerably less attention, with most of the research focusing on the timing of the endarterectomy rather than the factors associated with an increased risk of recurrence. In this context, the study by Eriksson et al, 1 published in the current issue, represents an important step in a relatively unexplored field.…”

The Issue of Optimal Timing of Carotid Revascularisation Is Both Relevant and Unresolved

“…The two recent studies published in the EJVES included 1 450 cases scheduled for or undergoing CEA between 2012 and 2018. 3,4 How recurrent events were recorded was not well described. In both studies, the risk of pre-operative stroke was z 1% at 14 days after the presenting event.…”

“…Both the recent EJVES studies claimed that improved medical treatment may explain the low observed recurrence rate. They used dual antiplatelet therapy 3 or a single antiplatelet in combination with anticoagulant treatment, 4 whereas in previously published studies patients foremost received single antiplatelet therapy. 5,6 However, none of these studies presented data on the timing of such medical treatment in relation to the recurrent events.…”

“…2 Early CAS seemed worse than early CEA, and CEA within two days had such a low postoperative risk (4.9%) that the optimal timing issue seems resolved. Moreover, two recent quite large studies published in the European Journal of Vascular and Endovascular Surgery (EJVES) reported that the risk of recurrent preoperative stroke is low (z1%), 3,4 indicating that the issue of optimal timing of revascularisation is irrelevant. However, because of methodological issues in the original studies, the issue of optimal revascularisation timing remains both relevant and unresolved.…”