Recurrent stroke risk is high after a single cerebrovascular event in patients with symptomatic 50-99% carotid stenosis: a cohort study.
BACKGROUND
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.


METHODS
This 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).


RESULTS
Of 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.


CONCLUSIONS
The 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.
Department of Pharmacology and Clinical Neuroscience and Department of Public Health and Clinical Medicine, Umeå University, 901 82 Umeå, Sweden. elias.johansson@neuro.umu.se.
Elias
E
Johansson
Per
P
Wester
D000368:Aged; D016893:Carotid Stenosis / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control