Early intervention needed for symptomatic carotid artery stenosis
MedWire News: More than one in 10 patients with minor cerebrovascular symptoms arising from carotid artery stenosis will have a repeat occurrence within 2 weeks of presentation, research shows.
This was despite patients receiving up-to-date medical therapy, with at least 90% receiving antihypertensives, lipid-lowering agents, and antiplatelets or anticoagulants, say Elias Johansson and colleagues from Umeå University in Sweden.
The study included 230 patients who presented with amaurosis fugax (one-sided visual loss lasting >24 hours), retinal artery occlusion (<24 hours), transient ischemic attack (TIA), or minor ischemic stroke and were subsequently diagnosed with at least 50% carotid artery stenosis. About three-quarters of the patients had at least 70% stenosis.
In all, 5.2% of patients had an ipsilateral ischemic stroke within 2 days of the initial event, 7.9% within 7 days, 11.2% within 14 days, and 18.6% within 90 days. Patients were excluded from the analysis at the point of undergoing carotid endarterectomy (CEA), so perioperative strokes were not counted.
Patients who presented with transient ischemic attack (n=70) or minor stroke (n=96) had the highest 14-day recurrent stroke rates, at 15.1% and 13.8%, respectively. Patients with amaurosis fugax (n=52) had the lowest 14-day stroke rate, at 1.9%, and the rate among those with retinal artery occlusion (n=12) was 8.3%.
After accounting for factors including age, gender, severity of carotid artery stenosis, and antihypertensive and lipid-lowering medications, the risk for recurrent stroke was increased 12.4-fold in patients with stroke as the presenting event and 10.2-fold in those with TIA, relative to those with amaurosis fugax.
"Because it is still somewhat uncertain if CEA within a few days confers an increased perioperative risk, it cannot be concluded that CEA within a few days is more beneficial than CEA within 2 weeks even though this study clearly points to this notion," the team writes in the International Journal of Stroke.
"Thus, controlled studies of the perioperative risk of CEA within a few days of the last event are warranted."
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By Eleanor McDermid