Time from symptoms to carotid endarterectomy or stenting and perioperative risk

James F Meschia, L. Nelson Hopkins, Irfan Altafullah, Lawrence R. Wechsler, Grant Stotts, Nicole R. Gonzales, Jenifer H. Voeks, George Howard, Thomas G Brott

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background and Purpose - Prior meta-analysis showed that carotid endarterectomy benefits decline with increasing surgical delay following symptoms. For symptomatic patients in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST), we assessed if differences in time between symptoms and carotid endarterectomy or carotid artery stenting are associated with differences in risk of periprocedural stroke or death. Methods - We analyzed the 1180 symptomatic patients in CREST who received their assigned procedure and had clearly defined timing of symptoms. Patients were classified into 3 groups based on time from symptoms to procedure: 60 days. Results - For carotid endarterectomy, risk of periprocedural stroke or death was not significantly different for the 2 later time periods relative to the earliest time period (hazard ratio, 0.74; 95% confidence interval, 0.22-2.49 for 15-60 days and hazard ratio, 0.91; 95% confidence interval, 0.25-3.33 for >60 days; P=0.89). For carotid artery stenting, risk of periprocedural stroke or death was also not significantly different for later time periods relative to the earliest time period (hazard ratio, 1.12; 95% confidence interval, 0.53-2.40 for 15-60 days and hazard ratio, 1.15; 95% confidence interval, 0.48-2.75 for >60 days; P=0.93). Conclusions - Time from symptoms to carotid endarterectomy or carotid artery stenting did not alter periprocedural safety, supporting early revascularization regardless of modality.

Original languageEnglish (US)
Pages (from-to)3540-3542
Number of pages3
JournalStroke
Volume46
Issue number12
DOIs
StatePublished - Dec 1 2015

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Carotid Endarterectomy
Carotid Arteries
Confidence Intervals
Stroke
Meta-Analysis
Safety

Keywords

  • carotid stenosis
  • endarterectomy, carotid
  • humans
  • stents
  • stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Meschia, J. F., Hopkins, L. N., Altafullah, I., Wechsler, L. R., Stotts, G., Gonzales, N. R., ... Brott, T. G. (2015). Time from symptoms to carotid endarterectomy or stenting and perioperative risk. Stroke, 46(12), 3540-3542. https://doi.org/10.1161/STROKEAHA.115.011123

Time from symptoms to carotid endarterectomy or stenting and perioperative risk. / Meschia, James F; Hopkins, L. Nelson; Altafullah, Irfan; Wechsler, Lawrence R.; Stotts, Grant; Gonzales, Nicole R.; Voeks, Jenifer H.; Howard, George; Brott, Thomas G.

In: Stroke, Vol. 46, No. 12, 01.12.2015, p. 3540-3542.

Research output: Contribution to journalArticle

Meschia, JF, Hopkins, LN, Altafullah, I, Wechsler, LR, Stotts, G, Gonzales, NR, Voeks, JH, Howard, G & Brott, TG 2015, 'Time from symptoms to carotid endarterectomy or stenting and perioperative risk', Stroke, vol. 46, no. 12, pp. 3540-3542. https://doi.org/10.1161/STROKEAHA.115.011123
Meschia JF, Hopkins LN, Altafullah I, Wechsler LR, Stotts G, Gonzales NR et al. Time from symptoms to carotid endarterectomy or stenting and perioperative risk. Stroke. 2015 Dec 1;46(12):3540-3542. https://doi.org/10.1161/STROKEAHA.115.011123
Meschia, James F ; Hopkins, L. Nelson ; Altafullah, Irfan ; Wechsler, Lawrence R. ; Stotts, Grant ; Gonzales, Nicole R. ; Voeks, Jenifer H. ; Howard, George ; Brott, Thomas G. / Time from symptoms to carotid endarterectomy or stenting and perioperative risk. In: Stroke. 2015 ; Vol. 46, No. 12. pp. 3540-3542.
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AU - Gonzales, Nicole R.

AU - Voeks, Jenifer H.

AU - Howard, George

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