Background: A 2004 report from two trials of carotid endarterectomy (CEA) indicated that its benefit was greatest when performed within 2 weeks of stroke onset. In 2006, the AHA recommended that carotid revascularization generally occur within 2 weeks of stroke.
Hypothesis: Since 2005, the time between stroke and CEA or carotid artery stenting (CAS) has decreased and the proportion of patients undergoing CEA or CAS within 2 weeks has increased.
Methods: Using administrative claims data from all nonfederal hospitals in CA, FL, and NY, we identified patients hospitalized with ischemic stroke between 2005 and 2012. We excluded those who did not undergo CEA or CAS within 90 days of admission for the index stroke. When stroke and CEA/CAS were documented in the same hospitalization, we included only strokes coded as present on admission so as to exclude periprocedural strokes in previously asymptomatic patients. All diagnoses and procedures were identified using previously validated ICD-9-CM codes. Our outcomes were the number of days between stroke and CEA/CAS and the proportion of patients who underwent CEA/CAS within the recommended 2-week period. Temporal trends were assessed using nonparametric correlation, chi-square test for trend, and logistic regression.
Results: We identified 14,414 patients with ischemic stroke who underwent CEA or CAS within 90 days. The median (interquartile range [IQR]) number of days from stroke to CEA/CAS decreased from 25 (5-48) in 2005 to 6 (3-24) in 2012 (P <0.001; Figure 1A). The proportion of patients who underwent CEA/CAS within 2 weeks of stroke increased from 40.1% in 2005 to 69.9% in 2012 (P <0.001; Figure 1B). The temporal trends in both outcomes were significant even after adjustment for patient demographics, state of residence, and comorbidities.
Conclusions: Since 2005, revascularization for symptomatic carotid disease has been progressively occurring sooner after presentation with stroke.