One-Year Risk of Stroke after Transient Ischemic Attack or Minor Stroke

Previous studies conducted between 1997 and 2003 estimated that the risk of stroke or an acute coronary syndrome was 12 to 20% during the first 3 months after a transient ischemic attack (TIA) or minor stroke. The TIAregistry.org project was designed to describe the contemporary profile, etiologic factors, and outcomes in patients with a TIA or minor ischemic stroke who receive care in health systems that now offer urgent evaluation by stroke specialists.We recruited patients who had had a TIA or minor stroke within the previous 7 days. Sites were selected if they had systems dedicated to urgent evaluation of patients with TIA. We estimated the 1-year risk of stroke and of the composite outcome of stroke, an acute coronary syndrome, or death from cardiovascular causes. We also examined the association of the ABCD(2) score for the risk of stroke (range, 0 [lowest risk] to 7 [highest risk]), findings on brain imaging, and cause of TIA or minor stroke with the risk of recurrent stroke over a period of 1 year.From 2009 through 2011, we enrolled 4789 patients at 61 sites in 21 countries. A total of 78.4% of the patients were evaluated by stroke specialists within 24 hours after symptom onset. A total of 33.4% of the patients had an acute brain infarction, 23.2% had at least one extracranial or intracranial stenosis of 50% or more, and 10.4% had atrial fibrillation. The Kaplan-Meier estimate of the 1-year event rate of the composite cardiovascular outcome was 6.2% (95% confidence interval, 5.5 to 7.0). Kaplan-Meier estimates of the stroke rate at days 2, 7, 30, 90, and 365 were 1.5%, 2.1%, 2.8%, 3.7%, and 5.1%, respectively. In multivariable analyses, multiple infarctions on brain imaging, large-artery atherosclerosis, and an ABCD(2) score of 6 or 7 were each associated with more than a doubling of the risk of stroke.We observed a lower risk of cardiovascular events after TIA than previously reported. The ABCD(2) score, findings on brain imaging, and status with respect to large-artery atherosclerosis helped stratify the risk of recurrent stroke within 1 year after a TIA or minor stroke

Status Update and Interim Results from the Asymptomatic Carotid Surgery Trial-2 (ACST-2)

Objectives: ACST-2 is currently the largest trial ever conducted to compare carotid artery stenting (CAS) with carotid endarterectomy (CEA) in patients with severe asymptomatic carotid stenosis requiring revascularization. Methods: Patients are entered into ACST-2 when revascularization is felt to be clearly indicated, when CEA and CAS are both possible, but where there is substantial uncertainty as to which is most appropriate. Trial surgeons and interventionalists are expected to use their usual techniques and CE-approved devices. We report baseline characteristics and blinded combined interim results for 30-day mortality and major morbidity for 986 patients in the ongoing trial up to September 2012. Results: A total of 986 patients (687 men, 299 women), mean age 68.7 years (SD ± 8.1) were randomized equally to CEA or CAS. Most (96%) had ipsilateral stenosis of 70-99% (median 80%) with contralateral stenoses of 50-99% in 30% and contralateral occlusion in 8%. Patients were on appropriate medical treatment. For 691 patients undergoing intervention with at least 1-month follow-up and Rankin scoring at 6 months for any stroke, the overall serious cardiovascular event rate of periprocedural (within 30 days) disabling stroke, fatal myocardial infarction, and death at 30 days was 1.0%. Conclusions: Early ACST-2 results suggest contemporary carotid intervention for asymptomatic stenosis has a low risk of serious morbidity and mortality, on par with other recent trials. The trial continues to recruit, to monitor periprocedural events and all types of stroke, aiming to randomize up to 5,000 patients to determine any differential outcomes between interventions. Clinical trial: ISRCTN21144362. © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved

Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy

Background: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86–1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91–1·32; p=0·21). Interpretation: Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable. Funding: UK Medical Research Council and Health Technology Assessment Programme

Carotid plaques - 3 years analysis

Indentify the factoprs influencing the carotid plaque progresssion. All consecutive patients from the ANTIQUE study (Atherosclerotic Plaque Characteristics Associated with a Progression Rate of the Plaque and a Risk of Stroke in Patients with the Carotid Bifurcation Plaque Study – ClinicalTrials.gov Identifier: NCT02360137) who underwent all clinical and ultrasound examinations over a 36-month period were included in the analysis. The ANTIQUE study inclusion criteria were as follows: patient age 30–90 years; atherosclerotic plaque localized in the carotid bifurcation or proximal part of the internal carotid artery with a width of ≥2.0 mm in B-mode transverse plane; sufficient image quality of atherosclerotic plaque in the carotid bifurcation and internal carotid artery (ICA) using ultrasound; self-sufficiency defined as a modified Rankin Scale score of 0–2 points; and signed informed consent was provided. Exclusion criteria were serious disease with a low probability of survival for at least three years and other objective obstacles preventing regular six-month ultrasound scans. Clinical examination All patients underwent neurological and physical examinations at six-month intervals over the course of 36 months. The examinations included blood pressure (one measurement at rest after the sonographic examination), height, and weight measurements (including calculation of body mass index), collection of demographic and medical data (age, gender, and medical history), occurrence of diseases (arterial hypertension, diabetes mellitus, hyperlipidemia, coronary heart disease, atrial fibrillation, myocardial infarction, or other cardiac diseases; stroke, including stroke type; and surgery or stenting of any vessels, including carotid arteries, coronary, or lower limb and other arteries), smoking, daily alcohol consumption dose, and medication use. Treatment All patients were treated using the “treating arteries instead of risk factors” strategy

Decade of CEA and CAS

Advances in surgical techniques and stenting devices for CEA over the past several decades have improved the prognosis of patients with carotid stenosis. In the present study, we examined improvements over a decade through a retrospective analysis of carotid interventions from a single hospital registry. Patients receiving CEA or CAS were compared for risk of cerebral infarction detected by magnetic resonance imaging, 30-day vascular morbidity and mortality, and effects on cognitive function during two periods separated by one decade. Data in the dataset contains from demographic data, outcomes (findings on control brain magnetic resonance and clinical data) and results of cognitive tests

CERCAS Trial

The purpose of the study is to compare the safety and effectiveness of carotid endarterectomy with stent removal (CEASR) and repeat percutaneous transluminal angioplasty with or without stenting (rePTA/S) in patients with carotid in-stent restenosis. Consecutive patients with carotid in-stent restenosis (≥80%) were randomly allocated to the CEASR or rePTA/S group. The incidence of residual stenosis after intervention, stroke, transient ischemic attack myocardial infarction and death 30 days and 1 year after intervention and restenosis 1 year after intervention between patients in CEASR and rePTA/S groups were statistically evaluated. All demographic data of enrolled patients and study results data are in the dataset.THIS DATASET IS ARCHIVED AT DANS/EASY, BUT NOT ACCESSIBLE HERE. TO VIEW A LIST OF FILES AND ACCESS THE FILES IN THIS DATASET CLICK ON THE DOI-LINK ABOV

Carotid plaques - 3 years analysis

Indentify the factoprs influencing the carotid plaque progresssion. All consecutive patients from the ANTIQUE study (Atherosclerotic Plaque Characteristics Associated with a Progression Rate of the Plaque and a Risk of Stroke in Patients with the Carotid Bifurcation Plaque Study – ClinicalTrials.gov Identifier: NCT02360137) who underwent all clinical and ultrasound examinations over a 36-month period were included in the analysis. The ANTIQUE study inclusion criteria were as follows: patient age 30–90 years; atherosclerotic plaque localized in the carotid bifurcation or proximal part of the internal carotid artery with a width of ≥2.0 mm in B-mode transverse plane; sufficient image quality of atherosclerotic plaque in the carotid bifurcation and internal carotid artery (ICA) using ultrasound; self-sufficiency defined as a modified Rankin Scale score of 0–2 points; and signed informed consent was provided. Exclusion criteria were serious disease with a low probability of survival for at least three years and other objective obstacles preventing regular six-month ultrasound scans. Clinical examination All patients underwent neurological and physical examinations at six-month intervals over the course of 36 months. The examinations included blood pressure (one measurement at rest after the sonographic examination), height, and weight measurements (including calculation of body mass index), collection of demographic and medical data (age, gender, and medical history), occurrence of diseases (arterial hypertension, diabetes mellitus, hyperlipidemia, coronary heart disease, atrial fibrillation, myocardial infarction, or other cardiac diseases; stroke, including stroke type; and surgery or stenting of any vessels, including carotid arteries, coronary, or lower limb and other arteries), smoking, daily alcohol consumption dose, and medication use. Treatment All patients were treated using the “treating arteries instead of risk factors” strategy

Decade of CEA and CAS

Advances in surgical techniques and stenting devices for CEA over the past several decades have improved the prognosis of patients with carotid stenosis. In the present study, we examined improvements over a decade through a retrospective analysis of carotid interventions from a single hospital registry. Patients receiving CEA or CAS were compared for risk of cerebral infarction detected by magnetic resonance imaging, 30-day vascular morbidity and mortality, and effects on cognitive function during two periods separated by one decade. Data in the dataset contains from demographic data, outcomes (findings on control brain magnetic resonance and clinical data) and results of cognitive tests.THIS DATASET IS ARCHIVED AT DANS/EASY, BUT NOT ACCESSIBLE HERE. TO VIEW A LIST OF FILES AND ACCESS THE FILES IN THIS DATASET CLICK ON THE DOI-LINK ABOV