Abstract 173: Current Treatment Status and Predictors of Subsequent Cerebral Ischemic Events in Transient Ischemic Attack Patients with Symptomatic Carotid Stenosis
Background and Purpose: Patients with symptomatic carotid stenosis (SCS) have recently tended to receive aggressive treatments including dual antiplatelet (AP) therapy and early carotid revascularization. The aim of this study was to clarify the current treatment status and predictors of subsequent cerebral ischemic events in TIA patients with SCS.
Methods: The PROMISE TIA registry prospectively enrolled 1,353 patients with TIA within 7 days of onset from 57 hospitals in Japan between June 2011 and December 2013. All SCS patients were extracted from this registry and divided into 3 stenosis groups; mild (<50%), moderate (50-69%) and severe (≥70%). The endpoint events were ischemic stroke/recurrent TIA within 90 days of index TIA.
Results: A total of 125 patients (103 men, 73.5±8.8 years old) was included. Thirty-seven patients (29.6%) had mild, 45 (36.0%) had moderate, and 43 (34.4%) had severe SCS. The rates of men and patients with amaurosis fugax (AF) were higher with increasing severity of SCS (men, 70.3% vs 80.0% vs 95.3%, p=0.012; AF, 0% vs 4.4% vs 16.3%, p=0.013). Acute-phase treatments using multiple AP with or without anticoagulant (AC) therapy were performed in 61 patients (48.8%), and 47 patients (37.6%) underwent revascularization within 90 days. The rates of patients receiving multiple AP with AC and those undergoing revascularization were higher with increasing severity of SCS (multiple AP with AC, 8.1% vs 37.8% vs 41.9%, p<0.001; revascularization, 10.8% vs 31.1% vs 67.4%, p<0.001). The endpoint events occurred in 9 patients (7.6%); 2 (5.7%) in mild group, 6 (14.0%) in moderate group and 1 (2.4%) in severe group (p=0.121). On multivariate analysis, dual TIA (HR, 5.9; 95%CI, 1.3-28) predicted the endpoint events.
Conclusion: In TIA patients with SCS, the rates of treatments with multiple AP and revascularization procedures were approximately 50% and 40%, respectively, being increasingly frequent with increasing severity of SCS. The 90-day risk of cerebral ischemic events was 7.6%, and patients with SCS who experienced dual TIA might need the aggressive treatments, regardless of severity of SCS.
Author Disclosures: M. Hayakawa: None. T. Uehara: None. T. Ohara: None. S. Sato: None. R. Suzuki: None. K. Toyoda: None. K. Minematsu: None.
- © 2015 by American Heart Association, Inc.