Factors associated with time delay to carotid stenting in patients with a symptomatic carotid artery stenosis.
Treatment of a symptomatic stenosis is known to be most beneficial within 14 days after the presenting event but this can frequently not be achieved in daily practice. The aim of this study was the assessment of factors responsible for this time delay to treatment. A retrospective analysis of a prospective two-center CAS database was carried out to investigate the potential factors that influence a delayed CAS treatment. Of 374 patients with a symptomatic carotid stenosis, 59.1% were treated beyond ≥14 days. A retinal TIA event (OR = 3.59, 95% CI 1.47-8.74, p < 0.01) was found to be a predictor for a delayed treatment, whereas the year of the intervention (OR = 0.32, 95% CI 0.20-0.50, p < 0.01) and a contralateral carotid occlusion (OR = 0.42, 95% CI 0.21-0.86, p = 0.02) were predictive of an early treatment. Similarly, within the subgroup of patients with transient symptoms, the year of the intervention (OR = 0.28, 95% CI 0.14-0.59, p < 0.01) was associated with an early treatment, whereas a retinal TIA as the qualifying event (OR = 6.96, 95% CI 2.37-20.47, p < 0.01) was associated with a delayed treatment. Treatment delay was most pronounced in patients with an amaurosis fugax, whereas a contralateral carotid occlusion led to an early intervention. Although CAS is increasingly performed faster in the last years, there is still scope for an even more accelerated treatment strategy, which might prevent future recurrent strokes prior to treatment.
Department of Neurology, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany. klaus.groeschel@medizin.uni-goettingen.de
Klaus
K
Gröschel
Sonja
S
Schnaudigel
Katrin
K
Wasser
Sara M
SM
Pilgram-Pastor
Ulrike
U
Ernemann
Michael
M
Knauth
Andreas
A
Kastrup
D000368:Aged; D016893:Carotid Stenosis / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
Clin Med (Lond). 2007 Dec;7(6):589-92
18193707
Neurology. 2004 Feb 24;62(4):569-73
14981172
Lancet. 2007 Jan 27;369(9558):283-92
17258668
Cerebrovasc Dis. 2007;24(2-3):231-5
17630483
Stroke. 2009 Aug;40(8):2776-82
19542057
Neurology. 2010 Apr 27;74(17):1351-7
20421579
Lancet. 2010 Mar 20;375(9719):985-97
20189239
Neurology. 2005 Aug 9;65(3):371-5
16087900
Lancet. 2004 Mar 20;363(9413):915-24
15043958
J Intern Med. 2008 Apr;263(4):404-11
18266661
Stroke. 2006 Feb;37(2):577-617
16432246
Stroke. 2007 Dec;38(12):3225-9
17962602
Lancet. 1998 May 9;351(9113):1379-87
9593407
Stroke. 2008 Aug;39(8):2325-30
18583556
BMJ. 2009 Jun 04;338:b1847
19502220
Cerebrovasc Dis. 2008;25(5):457-507
18477843
Lancet Neurol. 2007 Dec;6(12):1063-72
17993293
Stroke. 2009 Aug;40(8):2727-31
19498196
Lancet. 2005 Jul 2-8;366(9479):29-36
15993230
N Engl J Med. 1991 Aug 15;325(7):445-53
1852179