TY - JOUR
T1 - Stroke recurrence within the time window recommended for carotid endarterectomy
AU - Marnane, M.
AU - Chroinin, D. Ni
AU - Callaly, E.
AU - Sheehan, O. C.
AU - Merwick, A.
AU - Hannon, N.
AU - Horgan, G.
AU - Kyne, L.
AU - Moroney, J.
AU - McCormack, P. M.E.
AU - Dolan, E.
AU - Duggan, J.
AU - Williams, D.
AU - Crispino-O'Connell, G.
AU - Kelly, P. J.
N1 - Funding Information:
Study funding: Supported by an unrestricted educational grant from Pfizer Inc, the Mater College of Postgraduate Education and Research, the Irish Heart Foundation, the Health Services Executive, and the National Lottery of Ireland.
PY - 2011/8/23
Y1 - 2011/8/23
N2 - Objective: In the North Dublin Population Stroke Study, we investigated the risk of recurrent stroke within the 14-day time window recommended for endarterectomy. Methods: In a population-based prospective cohort study, all ischemic stroke patients were identified over 1 year and categorized into those with (CS-positive) and without (CS-negative) ipsilateral carotid stenosis (CS) (≥50% lumen narrowing). Nonprocedural stroke recurrence was determined at 72 hours and 7 and 14 days. Results: Of 365 ischemic stroke patients with carotid imaging, 51 were excluded due to posterior circulation or nonlateralizing stroke, ipsilateral carotid occlusion, or intracranial stenosis, leaving 314 included for analysis (36 CS-positive and 278 CS-negative). Recurrent stroke occurred in 5.6% (2/36) CS-positive and 0.4% (1/278) CS-negative patients by 72 hours of symptom onset (p = 0.003), 5.6% (2/36) CS-positive and 0.7% (2/278) CS-negative patients (p = 0.01) by 7 days, and in 8.3% (3/36) CS-positive and 1.8% (5/278) CS-negative patients by 14 days (p = 0.02). On multivariable Cox regression analysis, CS was the only independent predictor of recurrence at 72 hours (adjusted hazard ratio [HR] 36.1, 95% confidence interval [CI] 1.6- 837.5, p = 0.03), and 7 days (HR 9.1, 1.1-79.2, p = 0.05), with a trend at 14 days (HR 4.6, 0.9-22.8, p = 0.06). Conclusions: Although only a minority of patients with symptomatic CS had a recurrent stroke within 14 days, early recurrent stroke risk was high, particularly within the first 72 hours. Earlier carotid revascularization or improved acute medical treatment may reduce recurrence in this high-risk group.
AB - Objective: In the North Dublin Population Stroke Study, we investigated the risk of recurrent stroke within the 14-day time window recommended for endarterectomy. Methods: In a population-based prospective cohort study, all ischemic stroke patients were identified over 1 year and categorized into those with (CS-positive) and without (CS-negative) ipsilateral carotid stenosis (CS) (≥50% lumen narrowing). Nonprocedural stroke recurrence was determined at 72 hours and 7 and 14 days. Results: Of 365 ischemic stroke patients with carotid imaging, 51 were excluded due to posterior circulation or nonlateralizing stroke, ipsilateral carotid occlusion, or intracranial stenosis, leaving 314 included for analysis (36 CS-positive and 278 CS-negative). Recurrent stroke occurred in 5.6% (2/36) CS-positive and 0.4% (1/278) CS-negative patients by 72 hours of symptom onset (p = 0.003), 5.6% (2/36) CS-positive and 0.7% (2/278) CS-negative patients (p = 0.01) by 7 days, and in 8.3% (3/36) CS-positive and 1.8% (5/278) CS-negative patients by 14 days (p = 0.02). On multivariable Cox regression analysis, CS was the only independent predictor of recurrence at 72 hours (adjusted hazard ratio [HR] 36.1, 95% confidence interval [CI] 1.6- 837.5, p = 0.03), and 7 days (HR 9.1, 1.1-79.2, p = 0.05), with a trend at 14 days (HR 4.6, 0.9-22.8, p = 0.06). Conclusions: Although only a minority of patients with symptomatic CS had a recurrent stroke within 14 days, early recurrent stroke risk was high, particularly within the first 72 hours. Earlier carotid revascularization or improved acute medical treatment may reduce recurrence in this high-risk group.
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U2 - 10.1212/WNL.0b013e31822b00cf
DO - 10.1212/WNL.0b013e31822b00cf
M3 - Article
C2 - 21849640
AN - SCOPUS:80054034314
SN - 0028-3878
VL - 77
SP - 738
EP - 743
JO - Neurology
JF - Neurology
IS - 8
ER -