The risk of recurrent stroke at 24 months in patients with symptomatic carotid near‐occlusion: results from CAOS, a multicentre registry study

2019 ◽  
Vol 26 (11) ◽  
pp. 1391-1398 ◽  
Author(s):  
A. García‐Pastor ◽  
A. Gil-Núñez ◽  
J. M. Ramírez‐Moreno ◽  
N. González‐Nafría ◽  
J. Tejada ◽  
...  
Keyword(s):  
Recurrent Stroke ◽  
Registry Study ◽  
Symptomatic Carotid ◽  
Near Occlusion

Early risk of recurrent stroke in patients with symptomatic carotid near-occlusion: Results from CAOS, a multicenter registry study

2017 ◽  
Vol 12 (7) ◽  
pp. 713-719 ◽  
Author(s):  
Andrés García-Pastor ◽  
Antonio Gil-Núñez ◽  
José María Ramírez-Moreno ◽  
Noelia González-Nafría ◽  
Javier Tejada ◽  
...  
Keyword(s):  
Recurrent Stroke ◽  
Registry Study ◽  
Symptomatic Carotid ◽  
Early Risk ◽  
Near Occlusion ◽  
Multicenter Registry

Abstract TP135: Urgent Treatment for Symptomatic Carotid Stenosis: The Pittsburgh Revascularization and Treatment Emergently After Stroke Protocol

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Daniel Tonetti ◽  
Brian Jankowitz ◽  
Kenmuir Cynthia ◽  
Benjamin Zussman ◽  
Rahul Rao ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Primary Outcome ◽  
Recurrent Stroke ◽  
Carotid Stenting ◽  
Clinical Equipoise ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Recorded Data ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background: Patients with symptomatic carotid stenosis remain at high risk of early recurrent stroke without revascularization. The aim of this report is to analyze prospectively-recorded data from an institutional protocol that standardized the urgent (<48 hours) treatment of patients presenting with symptomatic carotid stenosis and underwent either carotid stenting (CAS) or carotid endarterectomy (CEA). Methods: All patients presenting over 28 months to a comprehensive stroke center with symptomatic carotid stenosis within 48 hours of index event were screened for inclusion. All patients were given dual antiplatelet therapy. If there was clinical equipoise between CEA and CAS, patients underwent angiography and subsequently revascularization if DSA demonstrated ≥50% stenosis. The primary outcome was a composite of stroke or death within 30 days. Results: 178 patients with a diagnosis of recently symptomatic carotid stenosis were included; 120 patients (67%) met criteria. 59 patients underwent CEA and 61 patients underwent CAS. There were not significant differences in the primary outcome; 3 patients (5.1%) in the CEA arm and 3 patients (4.9%) in the CAS arm met the primary outcome. Conclusion: In this prospective analysis, urgent revascularization for symptomatic carotid stenosis can be done with equivalently low rates of stroke or death, regardless of revascularization strategy.

Obstructed Flow

2016 ◽  
Author(s):  
Ji Y. Chong ◽  
Michael P. Lerario
Keyword(s):  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Transient Ischemic Attack ◽  
Recurrent Stroke ◽  
Early Period ◽  
Carotid Stenting ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Ischemic Attack

Patients with symptomatic carotid stenosis benefit from revascularization. The risk of recurrent stroke is highest during the early period after a transient ischemic attack or stroke. Carotid endarterectomy and carotid stenting are options for treatment and should be considered within the first 2 weeks if feasible.

scholarly journals Factors associated with recurrent stroke and recanalization in patients presenting with isolated symptomatic carotid occlusion

2015 ◽  
Vol 23 (1) ◽  
pp. 127-132 ◽  
Author(s):  
D. Damania ◽  
N. T.‐M. Kung ◽  
M. Jain ◽  
A. R. Jain ◽  
J. A. Liew ◽  
...  
Keyword(s):  
Recurrent Stroke ◽  
Carotid Occlusion ◽  
Symptomatic Carotid ◽  
Factors Associated

scholarly journals A pooled analysis of individual patient data from trials of endarterectomy for symptomatic carotid stenosis: efficacy of surgery in important subgroups

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 328-328
Author(s):  
Peter M Rothwell Dr ◽  
Sergei A Gutnikov Dr ◽  
Marc R Mayberg Professor ◽  
Charles P Warlow Professor ◽  
Henry Jm Barnett Professor
Keyword(s):  
Ischaemic Stroke ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Individual Patient Data ◽  
Patient Data ◽  
Surface Irregularity ◽  
Significant Heterogeneity ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Near Occlusion

65 Benefit from carotid endarterectomy (CEA) depends on the degree of symptomatic stenosis, but is also likely to be influenced by other clinical and angiographic characteristics. However, individual trials have been too small to allow reliable subgroup analysis. We therefore studied pooled individual patient data from the European Carotid Surgery Trial, the North American Symptomatic Carotid Endarterectomy Trial and the Veterans Administration trial #309. We determined the effect of CEA in 11 predefined subgroups: age (<65, 65–74, 75+), sex, type of presenting event (cerebral vs ocular; TIA vs stroke; lacunar vs non-lacunar), side of presenting event, months since last event (<1, 2–3, 4+), diabetes, plaque surface irregularity, near-occlusion, and contralateral carotid occlusion. There were statistically significant interactions between the risk of ipsilateral ischaemic stroke in the medical group and 8 of the 11 subgroup variables. In the surgery group, there were interactions between the operative risk of stroke and death and 6 subgroup variables. We therefore assessed heterogeneity of overall treatment effect (any ipsilateral ischaemic stroke and surgical stroke/death) in these subgroups. There was clinically and statistically significant heterogeneity within 5 subgroups: benefit from surgery increased with age, was greater in men than women; decreased with time since presenting event; was greater after stroke than TIA, and was absent in cases of near-occlusion. For example, in patients with 50–69% stenosis, the 5 yr absolute risk reduction was 10% (95% CI = 3–10, P=0.0005) in men and -3% (95% CI = -8 - 2, P=0.8) in women (overall interaction, P=0.003). There were also important differences in the effect of surgery for lacunar and non-lacunar stroke. Patients who are most likely to benefit from CEA cannot be identified using the degree of symptomatic carotid stenosis alone. Several other clinical and angiographic characteristics influence the efficacy of surgery. Optimal selection of patients will require a risk-modelling approach using multiple baseline characteristics.

Comment on the article “Symptomatic carotid near-occlusion causes a high risk of recurrent ipsilateral ischemic stroke” by Gu et al.

2019 ◽  
Vol 267 (3) ◽  
pp. 849-851
Author(s):  
Andrés García-Pastor ◽  
◽  
Antonio Gil-Núñez ◽  
José María Ramírez-Moreno ◽  
Noelia González-Nafría ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
High Risk ◽  
Symptomatic Carotid ◽  
Near Occlusion

Abstract 103: MR Perfusion Lesions in Minor Stroke and TIA Patients Predict New Brain Infarction at 7-days

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jun Lee ◽  
Michael Ke ◽  
Michael Mlynash ◽  
Sharan Mann ◽  
Manabu Inoue ◽  
...  
Keyword(s):  
Recurrent Stroke ◽  
Brain Infarction ◽  
Mean Transit Time ◽  
Intracranial Stenosis ◽  
High Rate ◽  
Minor Stroke ◽  
Imaging Evaluation ◽  
Symptomatic Carotid ◽  
Time To Peak ◽  
Stroke Center

Background: Although DWI-positive patients who present with transient symptoms have higher day-7 stroke rates than DWI-negative cohorts, little is known about the outcomes of TIA patients with focal perfusion lesions. The aim of the current study is to determine the day-7 recurrent stroke rate in TIA/minor stroke patients who have perfusion lesions on baseline MRI. Methods: Consecutive TIA and minor stroke (NIHSS < 4) patients who underwent baseline DWI and perfusion imaging as well as day-7 follow-up MRI with DWI and FLAIR at Yeungnam University Stroke Center in Korea were enrolled. Two perfusion parameters (Time to Peak and Mean Transit Time), DWI, ADC and FLAIR sequences were reviewed by 2 raters blinded to clinical outcomes. New brain infarction was defined by the presence of a new lesion on day-7 DWI and FLAIR. Symptomatic carotid and intracranial stenosis was assessed on baseline MRA. New neurological symptoms that occurred within 7 days were recorded. Results: Sixty-four patients met the inclusion criteria. Mean age was 64±13 years. Median ABCD2 was 4 (IQR: 3-5). At baseline, perfusion lesions were identified in 30 (47%), DWI lesions in 24 (38%) and symptomatic carotid and/or intracranial stenosis in 22 (34%) patients. Nine patients (14%) developed a new brain infarction on day-7 MRI, and all 9 patients had a baseline perfusion lesion. Thus, the rate of new brain infarction in patients with perfusion lesions at baseline was 30% (9/30). Of the 9 patients with new infarcts, 7 (78%) were clinically symptomatic, 5 (56%) had a negative baseline DWI, and 6 (67%) had normal vessel imaging. Conclusion: Our data suggest that the identification of a focal perfusion lesion during the imaging evaluation of TIA or minor stroke predicts a high rate of recurrent stroke within 1 week, even in the absence of identifiable vessel stenosis or DWI positivity on initial MRI.

scholarly journals Risk of Early Recurrent Stroke in Symptomatic Carotid Stenosis

2015 ◽  
Vol 61 (2) ◽  
pp. 570
Author(s):  
S. Strömberg ◽  
A. Nordanstig ◽  
T. Bentzel ◽  
K. Österberg ◽  
G.M.L. Bergström
Keyword(s):  
Carotid Stenosis ◽  
Recurrent Stroke ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis
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