Timing of Carotid Revascularization After Ischemic Stroke

Study Questions:

What is the current time interval between stroke and carotid endarterectomy (CEA) or carotid artery stenting (CAS) and the proportion of procedures occurring within 14 days?

Methods:

Using validated International Classification of Diseases, Ninth Revision, Clinical Modification codes and administrative claims data from nonfederal hospitals in CA, FL, and NY, the investigators identified patients with ischemic stroke who underwent CEA or CAS within 90 days of an ischemic stroke from 2005 to 2013. Outcomes were the number of days between stroke and CEA/CAS and the proportion of patients undergoing CEA/CAS within the recommended 14-day period. The authors assessed temporal trends using nonparametric correlation, the χ2 test for trend, and logistic regression.

Results:

The investigators identified 16,298 patients with ischemic stroke who underwent CEA/CAS within 90 days. The time from stroke to CEA/CAS decreased from 25 days (interquartile range, 5–48 days) in 2005 to 6 days (interquartile range, 3–17 days) in 2013 (p < 0.001). The proportion of patients who underwent CEA/CAS within 14 days of stroke increased from 40% (95% confidence interval, 37%–43%) in 2005 to 73% (95% confidence interval, 71%–76%) in 2013 (p < 0.001). These temporal trends remained significant after adjustment for patient demographics and comorbidities.

Conclusions:

The authors concluded that since 2005, revascularization for symptomatic carotid disease has been occurring progressively sooner after ischemic stroke.

Perspective:

This study reports that since 2006 when the American Heart Association released its recommendation to perform carotid revascularization procedures within 14 days of a stroke, progressively more of these procedures are being performed in a relatively timely manner among patients who present with ischemic stroke in CA, FL, and NY. Although this trend is encouraging, efforts to further promote earlier revascularization in the United States may still be beneficial because there remains a high risk of recurrent stroke even within the recommended 14-day window.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Prevention, Vascular Medicine, Cardiac Surgery and Arrhythmias, Interventions and Vascular Medicine

Keywords: Carotid Stenosis, Endarterectomy, Carotid, Myocardial Ischemia, Myocardial Revascularization, Stroke, Secondary Prevention, Treatment Outcome, Vascular Diseases


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