Early Carotid Intervention Linked to Functional Dependence After Stroke

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Researchers gauged incidence of new or worsened stroke, intracranial hemorrhage, and death as main complications of patients with moderate to severe strokes who underwent urgent carotid intervention.
Researchers gauged incidence of new or worsened stroke, intracranial hemorrhage, and death as main complications of patients with moderate to severe strokes who underwent urgent carotid intervention.

In patients with moderate or severe stroke (National Institutes of Health Stroke Scale [NIHSS] score, >10), urgent carotid intervention performed within but not exceeding 48 hours after hospital admission are more likely to have functional dependence at the time of discharge, according to study results published in the Journal of Vascular Surgery.

A tertiary referral center was used to obtain data from 120 urgent carotid interventions performed between January 2013 and April 2017. Stroke severity upon admission, defined by the NIHSS, represented a preoperative variable included in the analysis. Neurologic functional independence at hospital discharge, assessed by the modified Rankin scale (mRS) score, comprised the primary outcome. Functionally independent and functionally dependent scores were ≤2 and ≥3, respectively. New or worsened stroke, intracranial hemorrhage, and death represented the primary complications assessed in the study.

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In a bivariate analysis, a significant association was found between the presenting NIHSS score and days to procedure (P =.0048) and an association between admission NIHSS and mRS scores when patients were stratified into two groups with NIHSS scores of ≤10 and >10 (P =.0029). Patients with an NIHSS score of >10, indicative of larger strokes, had a 3.4-fold higher likelihood of functional dependence at discharge than patients with NIHSS scores of ≤10 (95% CI, 1.2-9.6; P =.024). Carotid intervention in ≤48 hours correlated with a worse mRS score in patients at hospital discharge than the mRS score in patients who underwent carotid intervention >48 hours (odds ratio 3.5; 95% CI, 1.4-8.7; P =.007), which suggests that urgent intervention may increase the risk for functional dependence. In addition, patients had a 3.4-fold higher likelihood of functional dependence at discharge if they underwent a procedure at 1 to 2 days vs >2 days (95% CI, 1.3-9.1; P =.014).

Limitations of this analysis included its retrospective nature, small patient cohort, and lack of randomized or controlled design.

"This study is based on 30-day outcomes of patients undergoing urgent carotid interventions in a regional transfer center encompassing >40 referring hospitals and emergency departments," the researchers added when discussing their study's limitations. "As such, intermediate follow-up for these patients was unreliable, and we are unable to gather enough data beyond 30 days."

Reference

Mihindu E, Mohammed A, Smith T, et al. Patients with moderate to severe strokes (NIHSS score >10) undergoing urgent carotid interventions within 48 hours have worse functional outcomes [published online January 8, 2019]. J Vasc Surg. doi:10.1016/j.jvs.2018.07.079

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