Risk of early recurrent stroke in symptomatic carotid stenosis after best medical therapy and before endarterectomy
| Autor: | K. Ellemann, B. Gottschalksen, Alan Owen-Falkenberg, Saeid Shahidi |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Risk
medicine.medical_specialty Ticlopidine Time Factors medicine.medical_treatment Carotid endarterectomy 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Fibrinolytic Agents Recurrence Medicine Humans Carotid Stenosis Prospective Studies Prospective cohort study Stroke Endarterectomy Aged Aged 80 and over Aspirin Endarterectomy Carotid business.industry Middle Aged medicine.disease Surgery Clopidogrel Stenosis Carotid Arteries Neurology Ischemic Attack Transient Platelet aggregation inhibitor Hydroxymethylglutaryl-CoA Reductase Inhibitors business 030217 neurology & neurosurgery Fibrinolytic agent Platelet Aggregation Inhibitors medicine.drug Follow-Up Studies New Zealand |
| Zdroj: | International journal of stroke : official journal of the International Stroke Society. 11(1) |
| ISSN: | 1747-4949 |
| Popis: | Background The early recurrence of neurological symptoms (NR) after urgent aggressive best medical therapy (BMT) in symptomatic carotid stenosis is not well documented. Aims To investigate the risk of ipsilateral NR after urgent aggressive BMT in patients with symptomatic (50–99%) carotid stenosis up to carotid endarterectomy (CEA), with emphasis on the first 14 days after index-event. Methods Prospective population based study, covering a period of 4½ years. NR rate was determined after initiation of urgent aggressive BMT and until CEA and compared to NR up to 90 days prior to index-event. Urgent BMT consisted of loading dose aspirin and clopidogrel thereafter therapy with aspirin and clopidogrel together with a statin. Results Of 8200 symptomatic patients (ischemic stroke, transient ischemic attack and ocular events), 250 (3%) patients underwent CEA, 47% within 14 days of the index-event and 99% within 14 days of surgical referral. The overall NR from index-event to CEA in symptomatic patients was significantly lower 1.6% (95% CI 0.5–4%) after BMT when compared with NR in the 90 days prior to referral to a stroke clinic 25% (95% CI 20–30%, p Conclusion Urgent aggressive BMT after index-event is associated with a significant reduction in the risk of early NR in CEA candidates. The early risk of recurrent stroke in patients with symptomatic significant carotid stenosis is dramatically reduced after urgent aggressive BMT in specialised stroke clinics. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|