http://stroke.ahajournals.org/content/48/1/225?etoc=
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Abstract
Background and Purpose—In
2006(the year of my stroke), 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 (P7lt;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.
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