title: Stroke recurrence within the time window recommended for carotid endarterectomy.
abstract: OBJECTIVE
  In the North Dublin Population Stroke Study, we investigated the risk of recurrent stroke within the 14-day time window recommended for endarterectomy.
  
  
  METHODS
  In a population-based prospective cohort study, all ischemic stroke patients were identified over 1 year and categorized into those with (CS-positive) and without (CS-negative) ipsilateral carotid stenosis (CS) (≥50% lumen narrowing). Nonprocedural stroke recurrence was determined at 72 hours and 7 and 14 days.
  
  
  RESULTS
  Of 365 ischemic stroke patients with carotid imaging, 51 were excluded due to posterior circulation or nonlateralizing stroke, ipsilateral carotid occlusion, or intracranial stenosis, leaving 314 included for analysis (36 CS-positive and 278 CS-negative). Recurrent stroke occurred in 5.6% (2/36) CS-positive and 0.4% (1/278) CS-negative patients by 72 hours of symptom onset (p =0.003), 5.6% (2/36) CS-positive and 0.7% (2/278) CS-negative patients (p =0.01) by 7 days, and in 8.3% (3/36) CS-positive and 1.8% (5/278) CS-negative patients by 14 days (p =0.02). On multivariable Cox regression analysis, CS was the only independent predictor of recurrence at 72 hours (adjusted hazard ratio [HR] 36.1, 95% confidence interval [CI] 1.6-837.5, p =0.03), and 7 days (HR 9.1, 1.1-79.2, p =0.05), with a trend at 14 days (HR 4.6, 0.9-22.8, p =0.06).
  
  
  CONCLUSIONS
  Although only a minority of patients with symptomatic CS had a recurrent stroke within 14 days, early recurrent stroke risk was high, particularly within the first 72 hours. Earlier carotid revascularization or improved acute medical treatment may reduce recurrence in this high-risk group.
authors.affiliation: Neurovascular Clinical Science Unit, Mater University Hospital/University College Dublin at Dublin Academic Medical Centre, Dublin, Ireland. mmarnane@gmail.com
authors.forename: M
authors.initials: M
authors.lastname: Marnane
authors.forename: D
authors.initials: D
authors.lastname: Ni Chroinin
authors.forename: E
authors.initials: E
authors.lastname: Callaly
authors.forename: O C
authors.initials: OC
authors.lastname: Sheehan
authors.forename: A
authors.initials: A
authors.lastname: Merwick
authors.forename: N
authors.initials: N
authors.lastname: Hannon
authors.forename: G
authors.initials: G
authors.lastname: Horgan
authors.forename: L
authors.initials: L
authors.lastname: Kyne
authors.forename: J
authors.initials: J
authors.lastname: Moroney
authors.forename: P M E
authors.initials: PM
authors.lastname: McCormack
authors.forename: E
authors.initials: E
authors.lastname: Dolan
authors.forename: J
authors.initials: J
authors.lastname: Duggan
authors.forename: D
authors.initials: D
authors.lastname: Williams
authors.forename: G
authors.initials: G
authors.lastname: Crispino-O'Connell
authors.forename: P J
authors.initials: PJ
authors.lastname: Kelly
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery; D015331:Cohort Studies; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012044:Regression Analysis; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods