Risk of Recurrent Stroke before Carotid Endarterectomy: The ANSYSCAP Study

Johansson, Elias; Arnerlöv, Conny; Wester, Per

doi:10.1111/j.1747-4949.2012.00790.x

Cited by 72 publications

(58 citation statements)

References 23 publications

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“…Table 4 summarizes the risk of early recurrent strokes in patients with symptomatic CA stenosis reported by various authors and observed in our patients. 12,18,21,23,25 The stroke risks observed by the various studies were quite variable, most likely because of differences in patient characteristics and management. Unlike in most other series, our patients had CA interventions rather early after symptom onset and admission.…”

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confidence: 99%

“…However, in many hospitals it might be difficult to plan for very early CEAs, and the periprocedural risk of adverse events in such early operations is largely unknown. Furthermore, data to estimate the risk of recurrence of cerebrovascular events within the first 72 hours after symptom onset are scarce, 18,23,25 and only 1 of these studies has analyzed the recurrence of ipsilateral ischemic strokes. 18 Therefore, we aimed to assess the following: 1) the ipsilateral recurrence rate within 72 hours of admission, in the period from 72 hours to 7 days, and after 7 days in patients presenting with nondisabling stroke, TIA, or AF, and an ipsilateral symptomatic CA stenosis of 50% or more, and 2) the risk of stroke in CA interventions performed within 48 hours of admission compared with the risk in later interventions.…”

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Risk of very early recurrent cerebrovascular events in symptomatic carotid artery stenosis

Mono¹,

Steiger²,

Findling³

et al. 2013

JNS

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Object The risk of recurrence of cerebrovascular events within the first 72 hours of admission in patients hospitalized with symptomatic carotid artery (CA) stenoses and the risks and benefits of emergency CA intervention within the first hours after the onset of symptoms are not well known. Therefore, the authors aimed to assess 1) the ipsilateral recurrence rate within 72 hours of admission, in the period from 72 hours to 7 days, and after 7 days in patients presenting with nondisabling stroke, transient ischemic attack (TIA), or amaurosis fugax (AF), and with an ipsilateral symptomatic CA stenosis of 50% or more, and 2) the risk of stroke in CA interventions within 48 hours of admission versus the risk in interventions performed after 48 hours. Methods Ninety-four patients were included in this study. These patients were admitted to hospital within 48 hours of a nondisabling stroke, TIA, or AF resulting from a symptomatic CA stenosis of 50% or more. The patients underwent carotid endarterectomy (85 patients) or CA stenting (9 patients). At baseline, the cardiovascular risk factors of the patients, the degree of symptomatic CA stenosis, and the type of secondary preventive treatment were assessed. The in-hospital recurrence rate of stroke, TIA, or AF ipsilateral to the symptomatic CA stenosis was determined for the first 72 hours after admission, from 72 hours to 7 days, and after 7 days. Procedure-related cerebrovascular events were also recorded. Results The median time from symptom onset to CA intervention was 5 days (interquartile range 3.00–9.25 days). Twenty-one patients (22.3%) underwent CA intervention within 48 hours after being admitted. Overall, 15 recurrent cerebrovascular events were observed in 12 patients (12.8%) in the period between admission and CA intervention: 3 strokes (2 strokes in progress and 1 stroke) (3.2%), 5 TIAs (5.3%), and 1 AF (1.1%) occurred within the first 72 hours (total 9.6%) of admission; 1 TIA (1.1%) occurred between 72 hours and 7 days, and 5 TIAs (5.3%) occurred after more than 7 days. The corresponding actuarial cerebrovascular recurrence rates were 11.4% (within 72 hours of admission), 2.4% (between 72 hours and 7 days), and 7.9% (after 7 days). Among baseline characteristics, no predictive factors for cerebrovascular recurrence were identified. Procedure-related cerebrovascular events occurred at a rate of 4.3% (3 strokes and 1 TIA), and procedures performed within the first 48 hours and procedures performed after 48 hours had a similar frequency of these events (4.5% vs 4.1%, respectively; p = 0.896). Conclusions The in-hospital recurrence of cerebrovascular events was quite low, but all recurrent strokes occurred within 72 hours. The risk of stroke associated with a CA intervention performed within the first 48 hours was not increased compared with that for later interventions. This raises the question of the optimal timing of CA intervention in symptomatic CA stenosis. To answer this question, more data are needed, preferably from large randomized trials.

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confidence: 99%

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Risk of very early recurrent cerebrovascular events in symptomatic carotid artery stenosis

Mono¹,

Steiger²,

Findling³

et al. 2013

JNS

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“…Most Nihilists remain unconvinced about the need to deliver expedited interventions; they think that a little delay is welcome (to reduce procedural risk), and they are generally dismissive about the validity and generalizability of small studies such as the study of Marnane. However, although the scientific message of Marnane may have been the prognostic importance of macrophage inflammation, perhaps its most important role has been to corroborate 6 other contemporary, natural history studies that found that the early risk of stroke after a TIA in patients with 50% to 99% stenoses was significantly higher than previously thought (5%-8% at 48 hours, 12,13 17% at 72 hours, 14 8%-22% at 7 days, [13][14][15][16] and 11%-25% at 14 days). 13,14,17 The obvious discrepancy between a 27% stroke risk at 28 days 1 versus a 21% risk at 5 years 2 is explained by there being 2 distinct cohorts of symptomatic patient in this debate.…”

Section: Naylor You May Delay But Time Will Not 659mentioning

confidence: 55%

You May Delay, but Time Will Not!

Naylor

2014

Stroke

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“…According to the recent literature, the risk of stroke recurrence is about 8-11% within the first 2 weeks for patients with SCAS [13,14], and at the same time there is evidence that early surgery in stable patients is not associated with an increased operative risk [15]. Bearing this in mind, the ambitious initial goal to operate all SCAS patients within 7-10 days has not been reached yet.…”

Section: Discussionmentioning

confidence: 99%

Management of the Treatment Delay in Symptomatic Carotid Artery Stenosis

Stiehm¹,

Björses

Kremer

2013

Eur Neurol

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Saving time to intervention is crucial in patients with symptomatic carotid artery stenosis (SCAS). We introduced a fast-track protocol (FTP). Time frames from the onset of symptoms to intervention before and after the introduction of an FTP were analyzed.SCAS patients (403 patients/405 procedures) were evaluated according to whether surgery was performed before (group 1) or after (group 2) the introduction of the FTP. Time frames to surgery, causes of delay and frequency of recurrent events are reported.The median time delay decreased from 17 to 12 days (p < 0.001), but time to ultrasound examination remained unchanged. Surgery was within 2 weeks in 41% in group 1 and in 57% in group 2 (p = 0.001). Of 181 (30%) patients treated according to the FTP, 54 were operated within 7 days (median), and 80% had the intervention within 2 weeks. Time to surgery decreased significantly after the introduction of the FTP.

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Risk of Recurrent Stroke before Carotid Endarterectomy: The ANSYSCAP Study

Abstract: The risk of recurrent ipsilateral ischemic stroke was high within the first days of the presenting event. Many recurrences would likely have been avoided if carotid endarterectomy had been performed within the first days of the presenting event.

Cited by 72 publications

References 23 publications

Risk of very early recurrent cerebrovascular events in symptomatic carotid artery stenosis

Risk of very early recurrent cerebrovascular events in symptomatic carotid artery stenosis

You May Delay, but Time Will Not!

Management of the Treatment Delay in Symptomatic Carotid Artery Stenosis

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