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(Stroke. 2009;40:2727.)
© 2009 American Heart Association, Inc.

Original Contributions

High Risk of Early Neurological Recurrence in Symptomatic Carotid Stenosis

Angel Ois, MD; Elisa Cuadrado-Godia, MD; Ana Rodríguez-Campello, MD; Jordi Jimenez-Conde, MD, PhD Jaume Roquer, MD, PhD

From the Servei de Neurologia, Hospital del Mar, IMAS, IMIM, Universidad Autonoma de Barcelona, Barcelona, Spain.

Correspondence to Dr Angel Ois, Servei de Neurologia, Hospital del Mar, IMAS, IMIM, Passeig Maritim 25-29, 08003, Barcelona, Spain. E-mail 94545{at}imas.imim.es

Background and Purpose— Few data are available on very early stroke recurrence evaluated within the first hours after onset of symptoms and outcome for unselected patients with first-ever mild stroke or TIA and symptomatic carotid stenosis 50%.

Methods— One hundred sixty-three patients with symptomatic carotid stenosis and initial mild stroke (121) or TIA (42) were evaluated within 6 hours from onset of symptoms in a single tertiary hospital. Neurological recurrence (NR) was defined as a clearly defined new neurological event (TIA or stroke) or an increase of 4 points in the initial NIHSS. The NR rate was determined at 72 hours, 7 days, and 14 days. Disability was defined as a score of 3 to 6 on the modified Rankin scale at 14 days.

Results— Forty-five patients (27.6%) had NR, including 6 patients with 2 episodes in different time periods: 34 (20.9%) within the first 72 hours; 11 (6.7%) between 72 hours and 7 days; and 6 (3.7%) at 14 days. Only carotid stenosis 70% was associated with NR; diabetes was marginally associated. At 2 weeks, 19 patients (11.7%) had disability; 14 of them experienced NR in the first 72 hours.

Conclusions— Patients with first-ever mild stroke or TIA and symptomatic carotid stenosis are at high risk for NR, especially within the first 72 hours. Our results suggest the necessity of testing pharmacological or interventional strategies for use during the hyperacute stroke phase in these patients.

Key Words: carotid stenosis • prognosis • stroke care