Effect of More Expedited Carotid Intervention on Recurrent Events

This study shows the benefit of reducing waiting time between acute events and intervention in patients with severe symptomatic carotid stenosis. Its outcomes support the efforts to reduce patient management. Moreover, it could be used as an indicator of clinical practice quality.

The risk of recurrent events after an ischemic event is significantly higher in the early phase because of extracranial carotid stenosis, which is why guidelines recommend a short delay (to perform either endarterectomy or stenting).

Data on all endarterectomy and all stenting on symptomatic stenosis patients were obtained from the Swedish Vascular Registry between 2008 and 2015. Data included all secondary events occurring after the presenting event up to 30 days follow up with inclusion of all pre- and post-intervention recurrences.

Read also: Safety of Early Carotid Artery Stenting in Symptomatic Patients.

Primary end point was recurrent cerebral ischemic event occurring after the presenting event up to 30 days of post-operative follow up.

The study looked at 6814 patients and showed a reduction of recurrent ischemic events (31% in 2008/09 to 21% in 2014/15; p=0.01) and, in parallel, mean time from index event to intervention was reduced from 13 to 7 days.

Read also: Is Stage 1 Hypertension as Defined in ACC/AHA Guidelines Associated with Any Events?

The proportion of recurrent events during waiting time was reduced from 25% to 18% (p<0.01) while periprocedural events (death and stroke) were 3.6%, and improved slightly during the studied period.

Conclusion

A substantial reduction of recurrent events is observed when mean waiting time between index procedure and intervention (endarterectomy or stenting) is reduced. This reduction of events during waiting time is in no way counterbalanced by an increase in periprocedural events.

Original title: Effect of More Expedited Carotid Intervention on Recurrent Ischaemic Event Rate: A National Audit.

Reference: Björn Kragsterman et al. Eur J Vasc Endovasc Surg (2018), article in press.

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