Abstract Body: Background:
The ideal timing of carotid artery stenting (CAS) in symptomatic internal carotid artery (ICA) stenosis is partly determined by the risk of stroke and/or death associated with timing of the procedure. We evaluated the risk of stroke and/or death within 30 days of CAS, considering various time intervals from the last ipsilateral cerebral/retinal ischemic event, using real-world data.
Methods:
We analyzed the data for symptomatic patients with ICA stenosis who underwent CAS as part of the national Vascular Quality Initiative (VQI). We divided the time interval between ipsilateral cerebral/retinal ischemic events and CAS into 0-1 days, 2-7 days, 8-14 days, 15-30 days, and 31-180 days. We performed logistic regression analysis to identify the effect of time interval strata between ipsilateral cerebral/retinal ischemic event and CAS on the combined endpoint of any stroke or death within 30 days after adjusting for adjusting for age, gender, severity of stenosis strata, ipsilateral cerebral/retinal ischemic event type, pre-operative use of aspirin, and pre-operative use of antiplatelets other than aspirin.
Results:
The cohort consisted of 5431 patients, of which 308 patients underwent CAS 0-1 days, 1680 patients 2-7 days, 804 patients 8-14 days, 725 patients 15-30 days, and 1914 patients 31-180 days after the ipsilateral cerebral/retinal ischemic event. The proportion of patients who developed any stroke or death within 30 days was greatest in the shorter time interval group (3.2% for Days 0-1) and lowest in the longer interval group (1.7% for Days 31-180). The risk of any stroke or death within 30 days was significantly higher for those undergoing CAS within 0-1 days (odds ratio [OR] 1.99, 95% confidence interval [CI] 1.01-3.79) compared to those undergoing CAS 31-180 days after the ischemic event. The odds ratio was non significantly different for patients who underwent CAS 2-7 days (OR 1.36, 95% CI 0.87-2.16), 8-14 days (OR 1.47, 95% CI 0.85-2.51), and 15-30 days (OR 1.25, 95% CI 0.67-2.24) after ipsilateral cerebral/retinal ischemic event.
Conclusion:
Our results highlight the increased risk of stroke and/or death when CAS is performed within the first 2 days after ipsilateral cerebral/retinal ischemic event. Identifying the ideal relationship between timing of CAS after the non-disabling ischemic event and the combined risk of stroke or death within 30 days will allow appropriate triage of symptomatic ICA stenosis patient.