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García-Pastor A, Gil-Núñez A, Ramírez-Moreno JM, González-Nafría N, Tejada J, Moniche F, Portilla-Cuenca JC, Martínez-Sánchez P, Fuentes B, Gamero-García MÁ, Alonso de Leciñana M, Masjuán J, Cánovas-Verge D, Aladro Y, Parkhutik V, Lago-Martín A, de Arce-Borda AM, Usero-Ruíz M, Delgado-Mederos R, Pampliega A, Ximenez-Carrillo Á, Bártulos-Iglesias M, Castro-Reyes E. The risk of recurrent stroke at 24 months in patients with symptomatic carotid near-occlusion: results from CAOS, a multicentre registry study. Eur J Neurol 2019; 26:1391-1398. [PMID: 31126001 DOI: 10.1111/ene.14006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/14/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The risk of recurrent stroke amongst patients with symptomatic carotid near-occlusion (SCNO) has not been clearly established, and its management remains controversial. The aim was to define the 24-month risk of recurrent stroke and to analyse the effect of the different treatment modalities (medical treatment and revascularization) in a population of patients with SCNO. METHODS A multicentre, nationwide, prospective study from January 2010 to May 2016 was performed. Patients with angiography-confirmed SCNO were included. The primary end-point was ipsilateral ischaemic stroke including periprocedural events within 24 months following the presenting event. Revascularization results and periprocedural complications, ipsilateral transient ischaemic attack, disabling or fatal stroke, and mortality were also noted. RESULTS The study population comprised 141 patients from 17 Spanish centres. Seventy patients (49.6%) were treated by revascularization (carotid stenting in 47, endarterectomy in 23). Complete revascularization was achieved in 58 patients (83%). Periprocedural stroke or death occurred in 5.7%. The 24-month cumulative incidence of the primary end-point was 11.1% (95% confidence interval 5.8-16.4; n = 15), 12% in the medical treatment group and 10.2% in the revascularization group, log-rank P = 0.817. The cumulative rates of ipsilateral ischaemic stroke or transient ischaemic attack, disabling or fatal stroke, and mortality, were 17%, 4.5% and 7.5%, respectively. CONCLUSIONS The rate of ipsilateral ischaemic stroke in patients with SCNO seems to be lower than the known rate associated with severe carotid stenosis without near-occlusion. The potential benefit of revascularization in the prevention of stroke in patients with SCNO may be influenced by the effectiveness and safety of the procedure.
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Affiliation(s)
- A García-Pastor
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - A Gil-Núñez
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - J Tejada
- Complejo Asistencial Universitario de León, León, Spain
| | - F Moniche
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | | | - B Fuentes
- Hospital Universitario La Paz, Madrid, Spain
| | | | | | - J Masjuán
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Y Aladro
- Hospital Universitario de Getafe, Getafe, Spain
| | - V Parkhutik
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - A Lago-Martín
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - M Usero-Ruíz
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - A Pampliega
- Hospital General Universitario de Alicante, Alicante, Spain
| | | | | | - E Castro-Reyes
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Abstract
BACKGROUND The risk of early stroke recurrence amongst patients with symptomatic carotid near-occlusion with and without full collapse is unknown. Therefore, the aim of this study was to analyse the 90-day risk of recurrent ipsilateral ischaemic stroke in patients with symptomatic carotid near-occlusion both with and without full collapse. METHODS This study was a secondary analysis of the Additional Neurological SYmptoms before Surgery of the Carotid Arteries: a Prospective study (ANSYSCAP). We prospectively analysed 230 consecutive patients with symptomatic 50-99% carotid stenosis or near-occlusion. Based on the combination of several imaging modalities, 205 (89%) patients were classified as having 50-99% carotid stenosis, and 10 (4%) and 15 (7%) as having near-occlusion with and without full collapse, respectively. The 90-day risk of recurrent ipsilateral ischaemic stroke was compared between these three groups. Only events that occurred before carotid endarterectomy were analysed. RESULTS The 90-day risk of recurrent stroke was 18% [95% confidence interval (CI) 12-25%; n = 29] for patients with 50-99% carotid stenosis, 0% for patients with near-occlusion without full collapse and 43% (95% CI 25-89%; n = 4) for patients with near-occlusion with full collapse (P = 0.035, log-rank test). The increased risk of recurrent ipsilateral ischaemic stroke for patients with symptomatic near-occlusion with full collapse remained significant after multivariable adjustment for age, sex and type of presenting event. CONCLUSIONS Patients with symptomatic carotid near-occlusion with full collapse might have a very high risk of stroke recurrence. Carotid endarterectomy could be considered for these patients.
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Affiliation(s)
- E Johansson
- Department of Pharmacology and Clinical Neuroscience and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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