title: Recurrent stroke in symptomatic carotid stenosis awaiting revascularization: A pooled analysis.
abstract: OBJECTIVE
  We aimed to quantify the risk and predictors of ipsilateral ischemic stroke in patients with symptomatic carotid stenosis awaiting revascularization (carotid endarterectomy [CEA] or carotid artery stenting) by pooling individual patient data from recent prospective studies with high rates of treatment with modern stroke prevention medications.
  
  
  METHODS
  Data were included from 2 prospective hospital-based registries (Umeå, Barcelona) and one prospective population-based study (Dublin). Patients with symptomatic 50%-99% carotid stenosis eligible for carotid revascularization were included and followed for early recurrent ipsilateral stroke or retinal artery occlusion (RAO).
  
  
  RESULTS
  Of 607 patients with symptomatic 50%-99% carotid stenosis, 377 met prespecified inclusion criteria. Ipsilateral recurrent ischemic stroke/RAO risk pre-revascularization was 2.7% (1 day), 5.3% (3 days), 11.5% (14 days), and 18.8% (90 days). On bivariate analysis, presentation with a cerebral vs ocular event was associated with higher recurrent stroke risk (log-rank p = 0.04). On multivariable Cox regression, recurrence was associated with older age (adjusted hazard ratio [HR] per 10-year increase 1.5, p = 0.02) with a strong trend for association with cerebral (stroke/TIA) vs ocular symptoms (adjusted HR 2.7, p = 0.06), but not degree of stenosis, smoking, vascular risk factors, or medications.
  
  
  CONCLUSIONS
  We found high risk of recurrent ipsilateral ischemic events within the 14-day time period currently recommended for CEA. Randomized trials are needed to determine the benefits and safety of urgent vs subacute carotid revascularization within 14 days after symptom onset.
authors.affiliation: From the Department of Public Health and Clinical Medicine, Umeå Stroke Centre (E.J., J.B., P.W.), and Department of Pharmacology and Clinical Neuroscience (E.J.), Umeå University, Sweden; Department of Neurology (E.C.-G., A.O., J.R.), Neurovascular Research Group, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain; and Neurovascular Unit for Translational and Therapeutics Research (D.H., P.J.K.), Mater University Hospital/Dublin Academic Medical Centre, Dublin, Ireland.
authors.forename: Elias
authors.initials: E
authors.lastname: Johansson
authors.affiliation: From the Department of Public Health and Clinical Medicine, Umeå Stroke Centre (E.J., J.B., P.W.), and Department of Pharmacology and Clinical Neuroscience (E.J.), Umeå University, Sweden; Department of Neurology (E.C.-G., A.O., J.R.), Neurovascular Research Group, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain; and Neurovascular Unit for Translational and Therapeutics Research (D.H., P.J.K.), Mater University Hospital/Dublin Academic Medical Centre, Dublin, Ireland. ecuadrado@hospitaldelmar.cat.
authors.forename: Elisa
authors.initials: E
authors.lastname: Cuadrado-Godia
authors.affiliation: From the Department of Public Health and Clinical Medicine, Umeå Stroke Centre (E.J., J.B., P.W.), and Department of Pharmacology and Clinical Neuroscience (E.J.), Umeå University, Sweden; Department of Neurology (E.C.-G., A.O., J.R.), Neurovascular Research Group, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain; and Neurovascular Unit for Translational and Therapeutics Research (D.H., P.J.K.), Mater University Hospital/Dublin Academic Medical Centre, Dublin, Ireland.
authors.forename: Derek
authors.initials: D
authors.lastname: Hayden
authors.affiliation: From the Department of Public Health and Clinical Medicine, Umeå Stroke Centre (E.J., J.B., P.W.), and Department of Pharmacology and Clinical Neuroscience (E.J.), Umeå University, Sweden; Department of Neurology (E.C.-G., A.O., J.R.), Neurovascular Research Group, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain; and Neurovascular Unit for Translational and Therapeutics Research (D.H., P.J.K.), Mater University Hospital/Dublin Academic Medical Centre, Dublin, Ireland.
authors.forename: Jakob
authors.initials: J
authors.lastname: Bjellerup
authors.affiliation: From the Department of Public Health and Clinical Medicine, Umeå Stroke Centre (E.J., J.B., P.W.), and Department of Pharmacology and Clinical Neuroscience (E.J.), Umeå University, Sweden; Department of Neurology (E.C.-G., A.O., J.R.), Neurovascular Research Group, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain; and Neurovascular Unit for Translational and Therapeutics Research (D.H., P.J.K.), Mater University Hospital/Dublin Academic Medical Centre, Dublin, Ireland.
authors.forename: Angel
authors.initials: A
authors.lastname: Ois
authors.affiliation: From the Department of Public Health and Clinical Medicine, Umeå Stroke Centre (E.J., J.B., P.W.), and Department of Pharmacology and Clinical Neuroscience (E.J.), Umeå University, Sweden; Department of Neurology (E.C.-G., A.O., J.R.), Neurovascular Research Group, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain; and Neurovascular Unit for Translational and Therapeutics Research (D.H., P.J.K.), Mater University Hospital/Dublin Academic Medical Centre, Dublin, Ireland.
authors.forename: Jaume
authors.initials: J
authors.lastname: Roquer
authors.affiliation: From the Department of Public Health and Clinical Medicine, Umeå Stroke Centre (E.J., J.B., P.W.), and Department of Pharmacology and Clinical Neuroscience (E.J.), Umeå University, Sweden; Department of Neurology (E.C.-G., A.O., J.R.), Neurovascular Research Group, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain; and Neurovascular Unit for Translational and Therapeutics Research (D.H., P.J.K.), Mater University Hospital/Dublin Academic Medical Centre, Dublin, Ireland.
authors.forename: Per
authors.initials: P
authors.lastname: Wester
authors.affiliation: From the Department of Public Health and Clinical Medicine, Umeå Stroke Centre (E.J., J.B., P.W.), and Department of Pharmacology and Clinical Neuroscience (E.J.), Umeå University, Sweden; Department of Neurology (E.C.-G., A.O., J.R.), Neurovascular Research Group, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain; and Neurovascular Unit for Translational and Therapeutics Research (D.H., P.J.K.), Mater University Hospital/Dublin Academic Medical Centre, Dublin, Ireland.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kelly
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000601:surgery; D016893:Carotid Stenosis / Q000150:complications* / Q000175:diagnosis; D002548:Cerebral Revascularization / Q000379:methods; D016894:Endarterectomy, Carotid / Q000379:methods; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000175:diagnosis; D013997:Time Factors; D016896:Treatment Outcome