title: The impact of timing on outcomes of carotid artery stenting in recently symptomatic patients.
abstract: OBJECTIVE
  We sought to determine whether the timing of carotid artery stenting (CAS) affects peri-procedural outcomes in recently symptomatic patients.
  
  
  BACKGROUND
  Early carotid endarterectomy following a stroke lowers the risk of recurrent ischemic events but has been associated with an increased risk of intracerebral hemorrhage. The optimal timing of CAS following a stroke is unknown.
  
  
  METHODS
  Using a single-center prospective CAS registry, we retrospectively analyzed data on consecutive CAS procedures over an 8-year period. Patients were separated into early (≤4 weeks) and late (>4 weeks) treatment groups based on time to CAS from symptom onset. Post-procedural hypertension was treated. Thirty-day incidence of stroke, intracerebral hemorrhage, myocardial infarction and death were recorded.
  
  
  RESULTS
  A total of 224 patients were treated for symptomatic lesions. The mean age was 71±10 years, and 63% were men. The median time for CAS was 8 days (0.2-30 days) and 90 days (31-180 days) respectively, for the early (n=122) and late (n=102) intervention groups. There were 4 (3.45%) periprocedural strokes in the early and 5 (5.95%) in the late CAS group (p=0.5). There was one hyperperfusion syndrome in each group. The 30-day stroke, myocardial infarction or death rates were similar between the early (6.03%) and late (8.33%) CAS groups, p=0.58. A multivariate analysis showed that age >80 years rather than timing of CAS was associated with adverse events.
  
  
  CONCLUSIONS
  CAS may be performed safely immediately following non-disabling strokes. Octogenarians may be at higher risk of complications.
authors: Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors: R
authors: R
authors: Lin
authors: M
authors: M
authors: Mazighi
authors: J
authors: J
authors: Yadav
authors: A
authors: A
authors: Abou-Chebl
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D016893:Carotid Stenosis / Q000097:blood / Q000473:pathology / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome