Timing of Carotid Revascularization Procedures After Ischemic Stroke.

TitleTiming of Carotid Revascularization Procedures After Ischemic Stroke.
Publication TypeJournal Article
Year of Publication2017
AuthorsReznik M, Kamel H, Gialdini G, Pandya A, Navi BB, Gupta A
Date Published2017 Jan
KeywordsAged, Aged, 80 and over, Brain Ischemia, Carotid Stenosis, Cerebral Revascularization, Cohort Studies, Endarterectomy, Carotid, Female, Humans, Male, Middle Aged, Population Surveillance, Stroke, Time Factors

BACKGROUND AND PURPOSE: In 2006, the American Heart Association recommended that carotid revascularization generally occurs within 2 weeks of stroke based on data from 2 trials of carotid endarterectomy (CEA). We aimed to determine whether the time between stroke and CEA or carotid artery stenting (CAS) has decreased and whether the proportion of procedures occurring within 14 days has increased.

METHODS: Using validated International Classification of Diseases, Ninth Revision, Clinical Modification codes and administrative claims data from nonfederal hospitals in CA, FL, and NY, we identified patients with ischemic stroke who underwent CEA or CAS within 90 days of an ischemic stroke from 2005 to 2013. Our 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. We assessed temporal trends using nonparametric correlation, the χ2 test for trend, and logistic regression.

RESULTS: We 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: Since 2005, revascularization for symptomatic carotid disease has been occurring progressively sooner after ischemic stroke.

Alternate JournalStroke
PubMed ID27924050
PubMed Central IDPMC5183494
Grant ListK23 NS082367 / NS / NINDS NIH HHS / United States
K23 NS091395 / NS / NINDS NIH HHS / United States
KL2 TR000458 / TR / NCATS NIH HHS / United States
R01 NS097443 / NS / NINDS NIH HHS / United States