Abstract
BackgroundRecurrent TIAs are thought to signal a high stroke risk. The aim of this study is to examine if repeated ischemic events increase the risk of recurrent ipsilateral stroke among patients with symptomatic 50-99% carotid stenosis.MethodsThis is a secondary analysis of the ANSYSCAP study, where we analyzed recurrent ipsilateral ischemic stroke before carotid endarterectomy in 230 consecutive patients with symptomatic 50-99% carotid stenosis. Here, we further analyzed the patients according to if they were clinically stable, unstable or highly unstable – respectively defined as having 0, 1 or ≥2 additional ipsilateral events within 7 days before and/or after the ischemic cerebrovascular event for which the patient sought health care (the presenting event).ResultsOf the 230 included patients, 155 (67%) were clinically stable, 47 (20%) were clinically unstable and 28 (12%) were clinically highly unstable. Eighteen patients suffered a stroke within 7 days; of these patients, 12 (67%) were clinically stable. The risk of recurrent ipsilateral ischemic stroke within 7 days was equally high for clinically stable (8%), unstable (9%) and highly unstable (7%) patients. Fourteen patients had 3–11 additional ipsilateral events; of these patients, only one suffered a recurrent ipsilateral ischemic stroke.ConclusionsThe seemingly clinical stable symptomatic 50-99% carotid stenosis patients without additional ipsilateral events have a high risk of recurrent stroke. Patients without additional events should undergo preoperative evaluation and carotid endarterectomy in the same expedient manner as patients with additional events.
Highlights
Recurrent Transient ischemic attack (TIA) are thought to signal a high stroke risk
We found that TIA or stroke as the presenting event incurred a higher risk of recurrent ipsilateral ischemic stroke than amaurosis fugax, but we detected no differences based on age, sex, or the degree of carotid stenosis on the symptomatic side [9]
We analyzed the risk of recurrent ipsilateral ischemic stroke based additional events before the presenting event and after the presenting event separately: we found non-significant trends that 1 additional ipsilateral event within 7 days before the presenting event incurred a higher risk of recurrent ipsilateral ischemic stroke than 0 or ≥2 events (Figure 3, Table 2); whereas the opposite pattern was observed in patients with 1 additional event after the presenting event (Figure 4, Table 2)
Summary
Recurrent TIAs are thought to signal a high stroke risk. The aim of this study is to examine if repeated ischemic events increase the risk of recurrent ipsilateral stroke among patients with symptomatic 50-99% carotid stenosis. The ABCD2 score was amended to ABCD3 by including one or more additional TIAs within 7 days as a risk factor [1]. These findings are based on patients with TIAs of mixed etiologies [1]. Patients with additional ischemic events and symptomatic carotid stenosis have a high risk of perioperative stroke [3,4,5]. Previous studies of patients with symptomatic carotid stenosis did not analyze if additional symptoms are risk factors for recurrent stroke before CEA [2,6,7,8]
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