Deans' stroke musings: Timing of Carotid Revascularization Procedures After Ischemic Stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Friday, January 6, 2017

Timing of Carotid Revascularization Procedures After Ischemic Stroke

And precisely WHY is this carotid revascularization needed? If your Circle of Willis is complete there is absolutely no reason to go through the dangers of carotid endarterectomy. Don't listen to me, I know nothing. I was quite glad when my right carotid completely closed up. Personally I think they should close the artery up instead of reaming it out if possible. My doctors in 2006 never even found my 80% blockage. That incompetency leads me to not trust anything my doctors tell me.
http://stroke.ahajournals.org/content/48/1/225

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Abstract

Background and Purpose—In 2006, the American Heart Association recommended that carotid revascularization generally occurs within 2 weeks of stroke based on data from 2 trials of carotid endarterectomy (CEA). We aimed to determine whether the time between stroke and CEA or carotid artery stenting (CAS) has decreased and whether the proportion of procedures occurring within 14 days has increased.

Methods—Using validated International Classification of Diseases, Ninth Revision, Clinical Modification codes and administrative claims data from nonfederal hospitals in CA, FL, and NY, we identified patients with ischemic stroke who underwent CEA or CAS within 90 days of an ischemic stroke from 2005 to 2013. Our outcomes were the number of days between stroke and CEA/CAS and the proportion of patients undergoing CEA/CAS within the recommended 14-day period. We assessed temporal trends using nonparametric correlation, the χ² test for trend, and logistic regression.

Results—We identified 16 298 patients with ischemic stroke who underwent CEA/CAS within 90 days. The time from stroke to CEA/CAS decreased from 25 days (interquartile range, 5–48 days) in 2005 to 6 days (interquartile range, 3–17 days) in 2013 (P<0.001). The proportion of patients who underwent CEA/CAS within 14 days of stroke increased from 40% (95% confidence interval, 37%–43%) in 2005 to 73% (95% confidence interval, 71%–76%) in 2013 (P<0.001). These temporal trends remained significant after adjustment for patient demographics and comorbidities.

Conclusions—Since 2005, revascularization for symptomatic carotid disease has been occurring progressively sooner after ischemic stroke.