By Matthew E. Fink, MD

Louis and Gertrude Feil Professor in Clinical Neurology and Chairman, Department of Neurology, Weill Cornell Medical College; Neurologist-in-Chief, New York Presbyterian Hospital

Dr. Fink reports he is a consultant for Procter & Gamble and Pfizer.

SOURCE: Johansson E, et al. Recurrent stroke in symptomatic carotid artery stenosis awaiting revascularization. A pooled analysis. Neurology 2016;86:498-504.

To determine the risk and predictors of recurrent stroke or retinal artery occlusion in patients with symptomatic carotid artery stenosis who are awaiting a revascularization procedure, the authors combined data from three prospective European studies of patients who had 50% to 99% symptomatic internal carotid artery stenosis and were scheduled for revascularization procedures. Current guidelines recommend that these procedures be performed within 2 weeks of the initial ischemic event, but the urgency and the risk of a recurrent stroke within those 2 weeks is uncertain.

From the pooled analysis, 377 patients met prespecified inclusion criteria, and their recurrent stroke events were analyzed. The rate of recurrent stroke or retinal artery occlusion was 2.7% after 1 day, 5.3% after 3 days, 11.5% after 14 days, and 18.8% at 90 days. They also demonstrated that if initial presentation was a cerebral ischemic event, compared to an ocular event, the risk of recurrent stroke was higher. The only other risk factor for recurrent stroke identified on a multivariate regression analysis was increased age, but not the degree of carotid stenosis, nor other vascular risk factors, nor any medications. The authors identified a significant early risk of recurrent stroke in patients with symptomatic carotid artery stenosis, and advise a prospective randomized trial to determine when the optimal time for revascularization should take place.