22. European Stroke Conference 2 Vascular surgery and neurosurgery 16:40 - 16:50 Impact of peri-procedural ischaemic brain lesions after stenting or endarterectomy on fu-ture cerebrovascular events in patients with symptomatic carotid artery stenosis – Results of the ICSS-MRI-study H. Gensicke1, P.J. Nederkoorn2, S. Macdonald3, P.A. Gaines4, P.A. Lyrer5, N. Peters6, A. van der Lugt7, W.P.T.M. Mali8, H.B. van der Worp9, S.T. Engelter10, M.M. Brown11, L.H. Bonati12 ICSS-MRI Substudy Investigators Department of Neurology, University Hospital Basel, Basel, SWITZERLAND1,Department of Neurology, Academic Medical Center Amsterdam, Amsterdam, THE NETHERLANDS2, Department of Radiology, Freeman Hospital, Newcastle-upon-Tyne, Newcastle, UNITED KINGDOM3, Sheffield Vascular Institute, Northern General Hospital, Sheffield, Sheffield, UNITED KINGDOM4, Department of Neurology, University Hospital Basel, Basel, SWIT-ZERLAND5, Department of Neurology, University Hospital Basel, Basel, SWITZERLAND6, Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, THE NETHERLANDS7, Department of Radiology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, THE NETHERLANDS8, Department of Neurolo-gy, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, THE NETHERLANDS9, Department of Neurology, University Hospital Basel, Basel, SWITZERLAND10, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, London, UNITED KINGDOM11, Department of Neurology, University Hospital Basel, Basel, SWITZERLAND12 Background: In the MRI substudy of the International Carotid Stenting Study (ICSS), new ischaemic brain lesions on diffusion-weighted imaging (DWI) occurred more often after stent-ing (CAS) than after endarterectomy (CEA). In the present analysis, we investigated whether peri-procedural DWI lesions were associated with increased risk of recurrent cerebrovascular events during long-term follow-up.Methods: 231 patients with symptomatic carotid stenosis were randomised to CAS (n=124) or CEA (n=107) and included in the ICSS-MRI substudy. Patients were followed at one and six months after treatment and then annually. We determined the rates of recurrent stroke or TIA in any territory, and recurrent stroke alone, occurring be-tween the immediate post-treatment MRI and end of follow-up. We then compared patients with (DWI+) and without (DWI-) new DWI lesions on the post-treatment scan in both treat-ment groups separately. Data were analysed using Kaplan-Meier statistics and Cox regression. esults: MRI was done a median of 1 day after treatment. Median time of follow-up after the scan was 4.1 years (IQR 3.0-5.2). In the CAS group, recurrent stroke or TIA occurred more of-ten among DWI+ patients (12/62) than among DWI- patients (6/62), with cumulative 5-year in-cidences of 22.8% (standard error 7.1%) and 8.8% (standard error 3.8%), respectively (hazard ratio 2.85; CI 95% 1.05-7.72, p=0.04; figure 1). 8 and 2 events occurred in DWI+ and DWI- patients respectively within 6 months after the MRI. However, the risk of stroke alone was not significantly increased. In CEA patients, there was no difference in recurrent cerebrovascular events between DWI+ and DWI- patients. onclusion: Ischaemic brain lesions discovered on DWI following CAS appear to be a marker of increased risk for recurrent cerebrovascular events. These finding might indicate that double antiplatelet therapy should be continued for six months after CAS in patients with peri-proce-dural DWI lesions. 16:30-18:00 Oral Session Room 14,15,16 Vascular surgery and neurosurgery & Management and economics Chairs: T. Brott, USA and T. Richards, UK 16:30 - 16:40 Death or stroke among patients with recently symptomatic carotid stenosis awaiting treat-ment with stenting or endarterectomy – a pooled analysis of individual patient data from EVA-3S, SPACE and ICSS U. Fisch1, L.H. Bonati2, S. Von Felten3, W.P.T. Mali4, O. Jansen5, G, Fraedrich6, G. Chatellier7, J.P. Becquemin8, A. Algra9, P. Ringleb10, M.M. Brown11, J.L. Mas12 Carotid Stenting Trialists Collaboration Department of Neurology and Stroke Unit, University Hospital Basel, Basel, SWITZER-LAND1, Department of Neurology and Stroke Unit, University Hospital Basel, Basel, SWIT-ZERLAND2, Clinical Trial Unit, University Hospital Basel, Basel, SWITZERLAND3, De-partment of Radiology, University Medical Center Utrecht, Utrecht, THE NETHERLANDS4, Neuroradiology, UKSH Campus Kiel, Kiel, GERMANY5, Department of Vascular Surgery, Medical University Innsbruck, Innsbruck, AUSTRIA6, Clinical Research Unit, Hôpital Eu-ropéen Georges Pompidou, Paris, FRANCE7, Service de chirurgie vasculaire cardiaque et tho-racique, Hôpital Henri Mondor, Paris, FRANCE8, Department of Neurology and Julius Center, University Medical Center Utrecht, Utrecht, THE NETHERLANDS9, Department of Neurology, University Hospital Heidelberg, Heidelberg, GERMANY10, De-partment of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UNITED KINGDOM11, Department of Neurology, Hôpital Sainte-Anne, Paris, FRANCE12 Background: Patients with symptomatic carotid stenosis are at high risk of early recurrent stroke. Current guidelines therefore recommend revascularisation within 2 weeks of the index event. Methods: The CSTC pooled data of all individual patients recruited in three European-based randomised trials (EVA-3S, SPACE, and ICSS) comparing carotid artery stenting (CAS) versus endarterectomy (CEA) for symptomatic carotid stenosis. The primary outcome event (POE) for this analysis was death or any stroke between randomisation and treatment, or up to 120 days after randomisation among patients not receiving treatment in this period. We investigated the association between baseline variables and time between randomisation and the POE. Results: 3345/3433 patients (97.4%) received CAS or CEA within 120 days of randomisation. Median time from qualifying event until randomisation was 19 (interquartile range 8-51) days in the whole population. Median time from randomisation until treatment was 6 (3-12) days in the CAS group, and 7 (3-14) days in the CEA group. 26% in the CAS group and 22% in the CEA group received treatment within 14 days of the qualifying event. Death or any stroke be-fore treatment occurred in 19 patients (CAS: 8, CEA: 11), all within 30 days of randomisation (cumulative Kaplan Meier estimate: 2.5%). In 2 of these patients, the date of the qualifying event was unknown, in 7 the POE occurred within 14 days of the qualifying event and in 10 more than 14 days after the qualifying event. The only significant predictor of the POE was se-verity of stenosis: all patients with the POE had severe (70-99%) stenosis (p=0.014). Discussion: Despite the fact that only 1 in 4 patients received treatment within 14 days of the qualifying event, only 2.5% of patients had a recurrent stroke or died before treatment. The risk is lower than expected from historical data, which may reflect advances in medical therapy. Pa-tients most at risk are those with severe degree of stenosis. 62 © 2013 S. Karger AG, Basel Scientific Programme
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