Urgent aggressive best medical therapy in symptomatic carotid stenosis reduced early recurrent neurological symptoms compared to the 90 days prior to referral (1.6% vs 25%; P<0.00001).
Cohort (n=250)
Does urgent aggressive best medical therapy reduce the risk of early recurrent neurological symptoms in patients with symptomatic carotid stenosis awaiting carotid endarterectomy?
Urgent aggressive medical therapy with dual antiplatelets and a statin dramatically reduces the risk of early recurrent stroke in patients with symptomatic carotid stenosis awaiting endarterectomy.
Absolute Event Rate: 1.6% vs 25%
p-value: p=<0.00001
BACKGROUND: The early recurrence of neurological symptoms (NR) after urgent aggressive best medical therapy (BMT) in symptomatic carotid stenosis is not well documented. AIMS: 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. CONCLUSION: 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.
Shahidi et al. (2015) conducted a cohort in Symptomatic (50-99%) carotid stenosis (n=250). Urgent aggressive best medical therapy vs. 90 days prior to referral was evaluated on Ipsilateral neurological symptom recurrence (NR) (p=<0.00001). Urgent aggressive best medical therapy in symptomatic carotid stenosis reduced early recurrent neurological symptoms compared to the 90 days prior to referral (1.6% vs 25%; P<0.00001).
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