title: Summary of Evidence on Early Carotid Intervention for Recently Symptomatic Stenosis Based on Meta-Analysis of Current Risks.
abstract: OBJECTIVE
  This study aimed to assess the evidence on the periprocedural (<30 days) risks of carotid intervention in relation to timing of procedure in patients with recently symptomatic carotid stenosis.
  
  
  METHODS
  A systematic literature review of studies published in the past 8 years reporting periprocedural stroke/death after carotid endarterectomy (CEA) and carotid stenting (CAS) related to the time between qualifying neurological symptoms and intervention was performed. Pooled estimates of periprocedural risk for patients treated within 0 to 48 hours, 0 to 7 days, and 0 to 15 days were derived with proportional meta-analyses and reported separately for patients with stroke and transient ischemic attack as index events.
  
  
  RESULTS
  Of 47 studies included, 35 were on CEA, 7 on CAS, and 5 included both procedures. The pooled risk of periprocedural stroke was 3.4% (95% confidence interval [CI], 2.6-4.3) after CEA and 4.8% (95% CI, 2.5-7.8) after CAS performed <15 days; stroke/death rates were 3.8% and 6.9% after CEA and CAS, respectively. Pooled periprocedural stroke risk was 3.3% (95% CI, 2.1-4.6) after CEA and 4.8% (95% CI, 2.5-7.8) after CAS when performed within 0 to 7 days. In hyperacute surgery (<48 hours), periprocedural stroke risk after CEA was 5.3% (95% CI, 2.8-8.4) but with relevant risk differences among patients treated after transient ischemic attack (2.7%; 95% CI, 0.5-6.9) or stroke (8.0%; 95% CI, 4.6-12.2) as index.
  
  
  CONCLUSIONS
  CEA within 15 days from stroke/transient ischemic attack can be performed with periprocedural stroke risk <3.5%. CAS within the same period may carry a stroke risk of 4.8%. Similar periprocedural risks occur after CEA and CAS performed earlier, within 0 to 7 days. Carotid revascularization can be safely performed within the first week (0-7 days) after symptom onset.
authors.affiliation: From the Unit of Vascular and Endovascular Surgery, Department of Surgical and Biomedical Sciences (P.D.R., A.M., L.F.) and Stroke Unit, Division of Cardiovascular Medicine (M.P., V.C.), Hospital S.M. Misericordia, Perugia, Italy; Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, United Kingdom (M.M.B.); Department of Neurology and Stroke Program, University of Miami Miller School of Medicine, FL (S.C.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Stroke Institute and Department of Neurology, UPMC Center for Neuroendovascular Therapy, University of Pittsburgh Medical Center, PA (T.J.); and Department of Neurology, Karolinska University Hospital, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (M.V.M.). plderango@gmail.com.
authors.forename: Paola
authors.initials: P
authors.lastname: De Rango
authors.affiliation: From the Unit of Vascular and Endovascular Surgery, Department of Surgical and Biomedical Sciences (P.D.R., A.M., L.F.) and Stroke Unit, Division of Cardiovascular Medicine (M.P., V.C.), Hospital S.M. Misericordia, Perugia, Italy; Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, United Kingdom (M.M.B.); Department of Neurology and Stroke Program, University of Miami Miller School of Medicine, FL (S.C.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Stroke Institute and Department of Neurology, UPMC Center for Neuroendovascular Therapy, University of Pittsburgh Medical Center, PA (T.J.); and Department of Neurology, Karolinska University Hospital, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (M.V.M.).
authors.forename: Martin M
authors.initials: MM
authors.lastname: Brown
authors.affiliation: From the Unit of Vascular and Endovascular Surgery, Department of Surgical and Biomedical Sciences (P.D.R., A.M., L.F.) and Stroke Unit, Division of Cardiovascular Medicine (M.P., V.C.), Hospital S.M. Misericordia, Perugia, Italy; Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, United Kingdom (M.M.B.); Department of Neurology and Stroke Program, University of Miami Miller School of Medicine, FL (S.C.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Stroke Institute and Department of Neurology, UPMC Center for Neuroendovascular Therapy, University of Pittsburgh Medical Center, PA (T.J.); and Department of Neurology, Karolinska University Hospital, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (M.V.M.).
authors.forename: Seemant
authors.initials: S
authors.lastname: Chaturvedi
authors.affiliation: From the Unit of Vascular and Endovascular Surgery, Department of Surgical and Biomedical Sciences (P.D.R., A.M., L.F.) and Stroke Unit, Division of Cardiovascular Medicine (M.P., V.C.), Hospital S.M. Misericordia, Perugia, Italy; Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, United Kingdom (M.M.B.); Department of Neurology and Stroke Program, University of Miami Miller School of Medicine, FL (S.C.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Stroke Institute and Department of Neurology, UPMC Center for Neuroendovascular Therapy, University of Pittsburgh Medical Center, PA (T.J.); and Department of Neurology, Karolinska University Hospital, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (M.V.M.).
authors.forename: Virginia J
authors.initials: VJ
authors.lastname: Howard
authors.affiliation: From the Unit of Vascular and Endovascular Surgery, Department of Surgical and Biomedical Sciences (P.D.R., A.M., L.F.) and Stroke Unit, Division of Cardiovascular Medicine (M.P., V.C.), Hospital S.M. Misericordia, Perugia, Italy; Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, United Kingdom (M.M.B.); Department of Neurology and Stroke Program, University of Miami Miller School of Medicine, FL (S.C.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Stroke Institute and Department of Neurology, UPMC Center for Neuroendovascular Therapy, University of Pittsburgh Medical Center, PA (T.J.); and Department of Neurology, Karolinska University Hospital, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (M.V.M.).
authors.forename: Tudor
authors.initials: T
authors.lastname: Jovin
authors.affiliation: From the Unit of Vascular and Endovascular Surgery, Department of Surgical and Biomedical Sciences (P.D.R., A.M., L.F.) and Stroke Unit, Division of Cardiovascular Medicine (M.P., V.C.), Hospital S.M. Misericordia, Perugia, Italy; Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, United Kingdom (M.M.B.); Department of Neurology and Stroke Program, University of Miami Miller School of Medicine, FL (S.C.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Stroke Institute and Department of Neurology, UPMC Center for Neuroendovascular Therapy, University of Pittsburgh Medical Center, PA (T.J.); and Department of Neurology, Karolinska University Hospital, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (M.V.M.).
authors.forename: Michael V
authors.initials: MV
authors.lastname: Mazya
authors.affiliation: From the Unit of Vascular and Endovascular Surgery, Department of Surgical and Biomedical Sciences (P.D.R., A.M., L.F.) and Stroke Unit, Division of Cardiovascular Medicine (M.P., V.C.), Hospital S.M. Misericordia, Perugia, Italy; Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, United Kingdom (M.M.B.); Department of Neurology and Stroke Program, University of Miami Miller School of Medicine, FL (S.C.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Stroke Institute and Department of Neurology, UPMC Center for Neuroendovascular Therapy, University of Pittsburgh Medical Center, PA (T.J.); and Department of Neurology, Karolinska University Hospital, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (M.V.M.).
authors.forename: Maurizio
authors.initials: M
authors.lastname: Paciaroni
authors.affiliation: From the Unit of Vascular and Endovascular Surgery, Department of Surgical and Biomedical Sciences (P.D.R., A.M., L.F.) and Stroke Unit, Division of Cardiovascular Medicine (M.P., V.C.), Hospital S.M. Misericordia, Perugia, Italy; Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, United Kingdom (M.M.B.); Department of Neurology and Stroke Program, University of Miami Miller School of Medicine, FL (S.C.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Stroke Institute and Department of Neurology, UPMC Center for Neuroendovascular Therapy, University of Pittsburgh Medical Center, PA (T.J.); and Department of Neurology, Karolinska University Hospital, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (M.V.M.).
authors.forename: Alessandra
authors.initials: A
authors.lastname: Manzone
authors.affiliation: From the Unit of Vascular and Endovascular Surgery, Department of Surgical and Biomedical Sciences (P.D.R., A.M., L.F.) and Stroke Unit, Division of Cardiovascular Medicine (M.P., V.C.), Hospital S.M. Misericordia, Perugia, Italy; Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, United Kingdom (M.M.B.); Department of Neurology and Stroke Program, University of Miami Miller School of Medicine, FL (S.C.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Stroke Institute and Department of Neurology, UPMC Center for Neuroendovascular Therapy, University of Pittsburgh Medical Center, PA (T.J.); and Department of Neurology, Karolinska University Hospital, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (M.V.M.).
authors.forename: Luca
authors.initials: L
authors.lastname: Farchioni
authors.affiliation: From the Unit of Vascular and Endovascular Surgery, Department of Surgical and Biomedical Sciences (P.D.R., A.M., L.F.) and Stroke Unit, Division of Cardiovascular Medicine (M.P., V.C.), Hospital S.M. Misericordia, Perugia, Italy; Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, United Kingdom (M.M.B.); Department of Neurology and Stroke Program, University of Miami Miller School of Medicine, FL (S.C.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Stroke Institute and Department of Neurology, UPMC Center for Neuroendovascular Therapy, University of Pittsburgh Medical Center, PA (T.J.); and Department of Neurology, Karolinska University Hospital, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (M.V.M.).
authors.forename: Valeria
authors.initials: V
authors.lastname: Caso
mesh_terms: D016893:Carotid Stenosis / Q000175:diagnosis / Q000601:surgery*; D061345:Early Medical Intervention / Q000379:methods* / Q000639:trends; D016894:Endarterectomy, Carotid / Q000379:methods* / Q000639:trends; D006801:Humans; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: carotid stenosis; endarterectomy; meta-analysis; stents; stroke