Type

Journal Article

Authors

P J Kelly
G Crispino-O'Connell
D Williams
J Duggan
E Dolan
P M E McCormack
J Moroney
L Kyne
G Horgan
N Hannon
and 5 others

Subjects

Medicine & Nursing

Topics
surgery female time factors tomography x ray computed carotid stenosis complications recurrence functional laterality stroke regression analysis epidemiology male magnetic resonance angiography endarterectomy carotid risk factors aged 80 and over ireland aged cohort studies humans middle aged

Stroke recurrence within the time window recommended for carotid endarterectomy. (2011)

Abstract In the North Dublin Population Stroke Study, we investigated the risk of recurrent stroke within the 14-day time window recommended for endarterectomy. In a population-based prospective cohort study, all ischemic stroke patients were identified over 1 year and categorized into those with (CS-positive) and without (CS-negative) ipsilateral carotid stenosis (CS) (≥50% lumen narrowing). Nonprocedural stroke recurrence was determined at 72 hours and 7 and 14 days. Of 365 ischemic stroke patients with carotid imaging, 51 were excluded due to posterior circulation or nonlateralizing stroke, ipsilateral carotid occlusion, or intracranial stenosis, leaving 314 included for analysis (36 CS-positive and 278 CS-negative). Recurrent stroke occurred in 5.6% (2/36) CS-positive and 0.4% (1/278) CS-negative patients by 72 hours of symptom onset (p =0.003), 5.6% (2/36) CS-positive and 0.7% (2/278) CS-negative patients (p =0.01) by 7 days, and in 8.3% (3/36) CS-positive and 1.8% (5/278) CS-negative patients by 14 days (p =0.02). On multivariable Cox regression analysis, CS was the only independent predictor of recurrence at 72 hours (adjusted hazard ratio [HR] 36.1, 95% confidence interval [CI] 1.6-837.5, p =0.03), and 7 days (HR 9.1, 1.1-79.2, p =0.05), with a trend at 14 days (HR 4.6, 0.9-22.8, p =0.06). Although only a minority of patients with symptomatic CS had a recurrent stroke within 14 days, early recurrent stroke risk was high, particularly within the first 72 hours. Earlier carotid revascularization or improved acute medical treatment may reduce recurrence in this high-risk group.
Collections Ireland -> University College Dublin -> PubMed

Full list of authors on original publication

P J Kelly, G Crispino-O'Connell, D Williams, J Duggan, E Dolan, P M E McCormack, J Moroney, L Kyne, G Horgan, N Hannon and 5 others

Experts in our system

1
Peter J Kelly
University College Dublin
Total Publications: 35
 
2
David Williams
Royal College of Surgeons in Ireland
Total Publications: 82
 
3
Joseph Duggan
University College Dublin
Total Publications: 11
 
4
Eamon Dolan
IT Blanchardstown
Total Publications: 42
 
5
Lorraine Kyne
University College Dublin
Total Publications: 25
 
6
Gillian Horgan
University College Dublin
Total Publications: 11
 
7
Niamh Hannon
University College Dublin
Total Publications: 11