Timing of Carotid Revascularization Procedures After Ischemic Stroke

My doctors didn't even find my 80% blockage in my right carotid artery after they found it had dissected. I was damn lucky that in the three years it took to completely close up that I didn't have another stroke.
http://stroke.ahajournals.org/content/48/1/225?etoc=

Michael Reznik, Hooman Kamel, Gino Gialdini, Ankur Pandya, Babak B. Navi, Ajay Gupta

https://doi.org/10.1161/STROKEAHA.116.015766

Stroke. 2017;48:225-228

Originally published December 6, 2016

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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.