Urgent Carotid Artery Revascularization Fraught with Higher Rates of Neurovascular Events in Symptomatic Carotid Artery Stenosis.

BACKGROUND

Symptomatic carotid artery stenosis requires timely intervention to reduce risk of recurrent stroke. However, the optimal timing of revascularization remains debated. This study evaluates outcomes in patients undergoing urgent (<48 hr), early (3-14 days), or delayed (>14 days) carotid artery revascularization.

METHODS

This retrospective cohort study included 186 interventions in symptomatic patients categorized by timing of intervention defined as urgent (<48 hr from symptom onset, n = 47), early (3-14 days, n = 90), and delayed (>14 days, n = 49). Baseline characteristics, procedural details, and outcomes were analyzed. Outcome measures included perioperative stroke, transient ischemic attack (TIA), myocardial infarction, and mortality at 30 days and on follow-up.

RESULTS

The cohort's mean age was 71.3 ± 9.6 years, with no difference among groups, and with a balanced sex distribution (P = 0.75). Comorbidities included hypertension, hyperlipidemia, and chronic kidney disease, which were similar across groups (P > 0.05). National Institutes of Health stroke scale on admission was significantly different between groups (urgent: 4.7 ± 4.6; early: 8.2 ± 8.1; delayed: 4.0 ± 5.2; P = 0.01). The level of disability measured through the modified Rankin scale at discharge demonstrated no significant difference between groups (urgent: 0.9 ± 1.3; early: 1.1 ± 1.3; delayed: 0.5 ± 1.0; P = 0.09). At 30 days, ipsilateral strokes/TIA occurred in 3 (6.4%) patients in the urgent group, and none in either the early group or delayed group (P = 0.02). Thirty-day mortality was observed in 2 (4.3%) patients in the urgent group and 1 (1.1%) in the early group (P = 0.23). The 30-day composite of stroke, TIA, myocardial infarction, or death was significantly higher in the urgent group (urgent: 8.5%, early: 1.1%, delayed: 0.0%; P = 0.02). At a mean follow-up of 14.6 ± 16.9 months, ipsilateral stroke rates were similar across groups (urgent: 4.3%, early: 5.6%, delayed: 4.1%; P = 1.00). All-cause mortality at follow-up occurred in 21.3% of urgent, 10.0% of early, and 10.2% of delayed patients (P = 0.17). Restenosis and reintervention rates at follow-up were significantly higher in the urgent (10.6%) and delayed (14.3%) groups than the early group (2.2%; P = 0.01).

CONCLUSION

Urgent carotid revascularization is associated with higher perioperative stroke/TIA rate than early and delayed interventions. Mid-term outcomes were comparable across groups. Restenosis and reintervention rates were higher in the urgent and delayed groups than the early intervention group.