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The impact of timing on outcomes of carotid artery stenting in recently symptomatic patients
  1. R Lin1,
  2. M Mazighi2,
  3. J Yadav3,
  4. A Abou-Chebl4
  1. 1Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
  2. 2Hopital Bishat, Paris, France
  3. 3Piedmont Hospital, Atlanta, Georgia, USA
  4. 4University of Louisville School of Medicine, Louisville, Kentucky, USA
  1. Correspondence to A Abou-Chebl, Director of Neurointerventional Services, Associate Professor of Neurology and Neurosurgery, Department of Neurology, University of Louisville School of Medicine, A113, 500 S. Preston, Louisville, KY 40202, USA; a0abou03{at}


Objectives We sought to determine whether the timing of carotid artery stenting (CAS) affects peri-procedural outcomes in recently symptomatic patients.

Background Early carotid endarterectomy following a stroke lowers the risk of recurrent ischemic events but has been associated with an increased risk of intracerebral hemorrhage. The optimal timing of CAS following a stroke is unknown.

Methods Using a single-center prospective CAS registry, we retrospectively analyzed data on consecutive CAS procedures over an 8-year period. Patients were separated into early (≤4 weeks) and late (>4 weeks) treatment groups based on time to CAS from symptom onset. Post-procedural hypertension was treated. Thirty-day incidence of stroke, intracerebral hemorrhage, myocardial infarction and death were recorded.

Results A total of 224 patients were treated for symptomatic lesions. The mean age was 71±10 years, and 63% were men. The median time for CAS was 8 days (0.2–30 days) and 90 days (31–180 days) respectively, for the early (n=122) and late (n=102) intervention groups. There were 4 (3.45%) periprocedural strokes in the early and 5 (5.95%) in the late CAS group (p=0.5). There was one hyperperfusion syndrome in each group. The 30-day stroke, myocardial infarction or death rates were similar between the early (6.03%) and late (8.33%) CAS groups, p=0.58. A multivariate analysis showed that age >80 years rather than timing of CAS was associated with adverse events.

Conclusions CAS may be performed safely immediately following non-disabling strokes. Octogenarians may be at higher risk of complications.

  • Stroke
  • angioplasty
  • intervention
  • stent

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  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the local institutional review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.