High Risk of Early Neurological Recurrence in Symptomatic Carotid Stenosis

• Published in: Stroke (1970) Vol. 40; no. 8; pp. 2727 - 2731
• Main Authors: Ois, Angel, Cuadrado-Godia, Elisa, Rodríguez-Campello, Ana, Jimenez-Conde, Jordi, Roquer, Jaume
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.08.2009
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Carotid Stenosis - complications; Carotid Stenosis - epidemiology; Cohort Studies; Female; Humans; Ischemic Attack, Transient - epidemiology; Ischemic Attack, Transient - etiology; Ischemic Attack, Transient - prevention & control; Male; Medical sciences; Middle Aged; Nervous System Diseases - epidemiology; Nervous System Diseases - etiology; Nervous System Diseases - prevention & control; Neurology; Neurosurgery; Risk Factors; Secondary Prevention; Skull, brain, vascular surgery; Stroke - epidemiology; Stroke - etiology; Stroke - prevention & control; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Vascular diseases and vascular malformations of the nervous system; Arterial disease; Vascular disease; Carotid stenosis; Stroke; Nervous system diseases; Prognosis; Central nervous system disease; Risk factor; Cardiovascular disease; stroke care; Cerebrovascular disease; Cerebral disorder
• ISSN: 0039-2499; 1524-4628; 1524-4628
• DOI: 10.1161/STROKEAHA.109.548032

Background and Purpose— Few data are available on very early stroke recurrence evaluated within the first hours after onset of symptoms and outcome for unselected patients with first-ever mild stroke or TIA and symptomatic carotid stenosis ≥50%. Methods— One hundred sixty-three patients with symptomatic carotid stenosis and initial mild stroke (121) or TIA (42) were evaluated within 6 hours from onset of symptoms in a single tertiary hospital. Neurological recurrence (NR) was defined as a clearly defined new neurological event (TIA or stroke) or an increase of 4 points in the initial NIHSS. The NR rate was determined at 72 hours, 7 days, and 14 days. Disability was defined as a score of 3 to 6 on the modified Rankin scale at 14 days. Results— Forty-five patients (27.6%) had NR, including 6 patients with 2 episodes in different time periods: 34 (20.9%) within the first 72 hours; 11 (6.7%) between 72 hours and 7 days; and 6 (3.7%) at 14 days. Only carotid stenosis ≥70% was associated with NR; diabetes was marginally associated. At 2 weeks, 19 patients (11.7%) had disability; 14 of them experienced NR in the first 72 hours. Conclusions— Patients with first-ever mild stroke or TIA and symptomatic carotid stenosis are at high risk for NR, especially within the first 72 hours. Our results suggest the necessity of testing pharmacological or interventional strategies for use during the hyperacute stroke phase in these patients.