title: Risk of early recurrent stroke in symptomatic carotid stenosis after best medical therapy and before endarterectomy.
abstract: BACKGROUND
  The early recurrence of neurological symptoms (NR) after urgent aggressive best medical therapy (BMT) in symptomatic carotid stenosis is not well documented.
  
  
  OBJECTIVE
  To investigate the risk of ipsilateral NR after urgent aggressive BMT in patients with symptomatic (50-99%) carotid stenosis up to carotid endarterectomy (CEA), with emphasis on the first 14 days after index-event.
  
  
  METHODS
  Prospective population based study, covering a period of 4½ years. NR rate was determined after initiation of urgent aggressive BMT and until CEA and compared to NR up to 90 days prior to index-event. Urgent BMT consisted of loading dose aspirin and clopidogrel thereafter therapy with aspirin and clopidogrel together with a statin.
  
  
  RESULTS
  Of 8200 symptomatic patients (ischemic stroke, transient ischemic attack and ocular events), 250 (3%) patients underwent CEA, 47% within 14 days of the index-event and 99% within 14 days of surgical referral. The overall NR from index-event to CEA in symptomatic patients was significantly lower 1.6% (95% CI 0.5-4%) after BMT when compared with NR in the 90 days prior to referral to a stroke clinic 25% (95% CI 20-30%, p < 0.00001). Peri-operative bleeding 5% (95% CI 3-8%) was comparable with other studies.
  
  
  CONCLUSIONS
  Urgent aggressive BMT after index-event is associated with a significant reduction in the risk of early NR in CEA candidates. The early risk of recurrent stroke in patients with symptomatic significant carotid stenosis is dramatically reduced after urgent aggressive BMT in specialised stroke clinics.
authors.affiliation: Department of Vascular Surgery, Regional Hospital Slagelse, Region Zealand, Denmark shsh@regionsjaelland.dk.
authors.forename: S
authors.initials: S
authors.lastname: Shahidi
authors.affiliation: Department of Vascular Surgery & Anesthesiology, Regional Hospital Slagelse, Region Zealand, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Owen-Falkenberg
authors.affiliation: Department of Vascular Surgery, Regional Hospital Slagelse, Region Zealand, Denmark.
authors.forename: B
authors.initials: B
authors.lastname: Gottschalksen
authors.affiliation: Department of Neurology, University Hospital Roskilde, Region Zealand, Denmark.
authors.forename: K
authors.initials: K
authors.lastname: Ellemann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000627:therapeutic use; D002339:Carotid Arteries / Q000187:drug effects / Q000473:pathology / Q000601:surgery; D016893:Carotid Stenosis / Q000150:complications / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy*; D000077144:Clopidogrel; D016894:Endarterectomy, Carotid; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D002546:Ischemic Attack, Transient / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D012008:Recurrence; D012306:Risk; D020521:Stroke / Q000150:complications / Q000453:epidemiology* / Q000628:therapy*; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D005343:Fibrinolytic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: Ischemic stroke; carotid endarterectomy; carotid stenosis; dual antiplatelet therapy; recurrent event