Swedish Study Shows Expedited Carotid Intervention Improves Recurrent Ischemic Event Rate
October 10, 2018—Findings from a national audit in Sweden to study the effect of more expedient carotid interventions on the rate of recurrent ischemic events were published by Björn Kragsterman, MD, et al in European Journal of Vascular and Endovascular Surgery (2018;56:467–474).
The background of the study is that the benefit of carotid endarterectomy (CEA) or carotid artery stenting (CAS) for symptomatic stenosis depends on the timing in relation to the presenting event.
Guidelines recommend a short delay because the risk of recurrent events is highest in the early phase.
However, the investigators in this study found that a substantial reduction in the secondary ischemic event rate was observed when the median waiting time for CEA/CAS was reduced. This reduction was not counterbalanced by any increase in the perioperative complication rate, noted the investigators in EJVES.
The investigators obtained data on all CEA and CAS for symptomatic stenosis, including both recurrent ischemic events during the waiting time to carotid intervention and perioperative 30-day complication rates. They analyzed procedures from the Swedish Vascular Registry between May 2008 and December 2015. Additionally, the National Prescribed Drug Registry provided data on preventive medication before hospitalization with the presenting event. The primary endpoint was a recurrent cerebral ischemic event occurring after the presenting event up to 30 days of postoperative follow-up.
As summarized in EJVES, the study was composed of 6,814 procedures for symptomatic carotid stenosis. The investigators recorded the proportion of recurrent ischemic events—defined as all secondary events occurring after the presenting event at up to 30-day follow-up with inclusion of all pre- and postintervention recurrences.
The investigators found that these recurrent events decreased over time, from 31% in 2008 to 2009 to 21% in 2014 to 2015 (P < .01, chi-square test). In parallel, the median waiting time for carotid intervention decreased from 13 days (interquartile range [IQR], 6–27 days) to 7 days (IQR, 4–12 days). Baseline demographic variables and comorbidities were similar during the study period. The proportion of preoperative recurrences were reduced from 25% to 18% (P < .01, chi-square test). The perioperative stroke and/or death rate was 3.6% and improved slightly during the study, reported the investigators in EJVES.