High risk of early neurological recurrence in symptomatic carotid stenosis.
OBJECTIVE
Few data are available on very early stroke recurrence evaluated within the first hours after onset of symptoms and outcome for unselected patients with first-ever mild stroke or TIA and symptomatic carotid stenosis > or =50%.


METHODS
One hundred sixty-three patients with symptomatic carotid stenosis and initial mild stroke (121) or TIA (42) were evaluated within 6 hours from onset of symptoms in a single tertiary hospital. Neurological recurrence (NR) was defined as a clearly defined new neurological event (TIA or stroke) or an increase of 4 points in the initial NIHSS. The NR rate was determined at 72 hours, 7 days, and 14 days. Disability was defined as a score of 3 to 6 on the modified Rankin scale at 14 days.


RESULTS
Forty-five patients (27.6%) had NR, including 6 patients with 2 episodes in different time periods: 34 (20.9%) within the first 72 hours; 11 (6.7%) between 72 hours and 7 days; and 6 (3.7%) at 14 days. Only carotid stenosis > or =70% was associated with NR; diabetes was marginally associated. At 2 weeks, 19 patients (11.7%) had disability; 14 of them experienced NR in the first 72 hours.


CONCLUSIONS
Patients with first-ever mild stroke or TIA and symptomatic carotid stenosis are at high risk for NR, especially within the first 72 hours. Our results suggest the necessity of testing pharmacological or interventional strategies for use during the hyperacute stroke phase in these patients.
Ois
Angel
A
Servei de Neurologia, Hospital del Mar, IMAS, IMIM, Passeig Maritim 25-29, 08003, Barcelona, Spain. 94545@imas.imim.es
Cuadrado-Godia
Elisa
E
Rodríguez-Campello
Ana
A
Jimenez-Conde
Jordi
J
Roquer
Jaume
J
D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000150:complications* / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors