title: Risk of early recurrent stroke in symptomatic carotid stenosis.
abstract: OBJECTIVE
  The risk of recurrent stroke in patients with symptomatic carotid artery stenosis is highest in the first weeks after a transient ischemic attack (TIA) or minor stroke and can be reduced with carotid endarterectomy (CEA). The optimal timing of CEA remains a controversial issue since very urgent CEA is associated with an increased procedural risk. The aim of this study was to determine the risk of very early recurrent stroke in a population with symptomatic high grade carotid stenosis.
  
  
  METHODS
  Data were analyzed on all patients with ocular TIA, TIA, or minor stroke with >70% carotid stenosis as assessed by carotid ultrasound at Sahlgrenska University Hospital during the periods 2004-2006 and 2010-2012. The two time periods were chosen to minimize selection bias and to analyze changes over time. The risk of recurrent stroke within 30 days of the referring event was assessed.
  
  
  RESULTS
  397 patients with symptomatic carotid stenosis were identified. The risk of recurrent stroke in the total cohort was 2.0% (CI 95% 0.6-3.4) by day 2, 4.0% (CI 95% 2.0-5.9) by day 7, and 7.5% (CI 95% 4.4-10.6) by day 30. There was no significant difference between the two time periods. Patients with minor stroke had a significantly higher risk of recurrent stroke than patients with TIA or ocular TIA as the referring event.
  
  
  CONCLUSIONS
  The data suggest that the early risk of recurrent stroke in symptomatic significant carotid stenosis is not as high as some earlier studies have shown. The risk is similar to several studies in which a modern medical treatment regime could be assumed.
authors.affiliation: Department of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; The Sahlgrenska Center for Cardiovascular and Metabolic Research, Wallenberg Laboratory, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden. Electronic address: sofia.stromberg@vgregion.se.
authors.forename: S
authors.initials: S
authors.lastname: Strömberg
authors.affiliation: The Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Nordanstig
authors.affiliation: The Sahlgrenska Center for Cardiovascular and Metabolic Research, Wallenberg Laboratory, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: T
authors.initials: T
authors.lastname: Bentzel
authors.affiliation: Department of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Österberg
authors.affiliation: The Sahlgrenska Center for Cardiovascular and Metabolic Research, Wallenberg Laboratory, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: G M L
authors.initials: GM
authors.lastname: Bergström
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020757:Amaurosis Fugax / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006785:Hospitals, University; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex
keywords: Carotid disease; Carotid stenosis; Stroke; Transient ischemic attack