Very Urgent Intervention for Symptomatic Carotid Disease Linked to Increased Stroke Risk


November 29, 2018—A new meta-analysis shows that very urgent carotid artery intervention for the treatment of symptomatic carotid artery disease was associated with an increased risk of stroke within 30 days. The meta-analysis was published by David Milgrom, MD, et al in European Journal of Vascular & Endovascular Surgery (EJVES; 2018;56:622–631).

As reported in EJVES, the investigators set out to examine the outcomes of very urgent (defined as < 48 hours from a neurological event) versus urgent (defined as > 48 hours from a neurological event) carotid intervention to treat symptomatic carotid disease.

Researchers collected periprocedural outcome data on carotid intervention in relation to the length of time from the neurologic event from 12 observational studies and one randomized controlled trial. In total, 5,751 interventions, 5,385 carotid endarterectomies, and 366 carotid artery stenting procedures were included in the quantitative analysis.

Primary endpoints were defined as ipsilateral stroke and death; secondary endpoints were transient ischemic attack (TIA) and myocardial infarction (MI).

When compared with urgent carotid intervention, very urgent carotid intervention was associated with increased risk of stroke within 30 days (odds ratio [OR], 2.19; 95% confidence interval [CI], 1.46–3.26; P < .001). No significant difference in mortality (OR, 1.55; 95% CI, 0.81–2.96; P = .19), TIA (OR, 1.33; 95% CI, 0.55–3.19; P = .52), or MI (OR, 1.33; 95% CI, 0.41–4.33; P = .64) was shown, reported investigators in EJVES.


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