Reduction in Early Stroke Risk in Carotid Stenosis With Transient Ischemic Attack Associated With Statin Treatment

In patients with acute symptomatic carotid stenosis, statin pretreatment is associated with reduced stroke risk. Carotid endarterectomy (CEA) in patients with associated symptoms is highly effective for secondary stroke prevention. Maximum benefit appears to be in those who undergo surgery ≤2 weeks of symptom onset; however, the safety of very early CEA has been questioned. Data from the Swedish Vascular Registry indicated an 11.5% stroke and death rate in patients undergoing CEA ≤48 hours of symptom onset. This is a fourfold increase in the odds of a poor outcome compared with those undergoing CEA from 3 to 7 days (Strömberg S et al, Stroke 2012;43:1331-5). In patients with acute coronary syndromes, statin medications appear beneficial for secondary vascular prevention secondary to their plaque-stabilizing effects. There are, however, few data for patients with unstable carotid stenosis addressing early stroke recurrence and statin pretreatment at the time of symptoms or statins begun acutely after symptoms. The authors hypothesize that statin pretreatment at transient ischemic attack (TIA) onset would be associated with reduced early stroke risk in patients with TIA and carotid stenosis and that this would include those awaiting CEA. The authors analyze data from 2770 patients with TIAs from 11 centers; 387 had ipsilateral carotid stenosis. ABCD2 (age ≥60 years; blood pressure ≥140/90 mmHg at initial evaluation; clinical features of the TIA; duration of symptoms,...
Source: Journal of Vascular Surgery - Category: Surgery Authors: Tags: Abstracts Source Type: research