THE DELAY IN REPORTING SYMPTOMS OF CAROTID-ARTERY STENOSIS IN AN AT-RISK POPULATION - THE ASYMPTOMATIC CAROTID ATHEROSCLEROSIS STUDY EXPERIENCE - A STATEMENT OF CONCERN REGARDING WATCHFUL WAITING
Je. Castaldo et al., THE DELAY IN REPORTING SYMPTOMS OF CAROTID-ARTERY STENOSIS IN AN AT-RISK POPULATION - THE ASYMPTOMATIC CAROTID ATHEROSCLEROSIS STUDY EXPERIENCE - A STATEMENT OF CONCERN REGARDING WATCHFUL WAITING, Archives of neurology, 54(10), 1997, pp. 1267-1271
Objective: To examine whether patients in the Asymptomatic Carotid Ath
erosclerosis Study reported symptoms of cerebral and retinal ischemia
promptly to the investigating team. Design: Cohort study within the As
ymptomatic Carotid Atherosclerosis Study, a prospective, randomized, m
ulticenter clinical trial, with a median follow-up time of 2.7 years.
Setting: Thirty-nine clinical sites across the United States and Canad
a. Patients: Patients with asymptomatic carotid artery stenosis (great
er than or equal to 60% reduction in diameter) who experienced either
a transient ischemic attack (TIA) (n=115) or stroke (n=127) during the
follow-up period, as verified by an external committee. Main Outcome
Measure: Proportion of patients who reported cerebrovascular symptoms
to a study nurse or physician within 3 days of occurrence. Results: Th
irty-seven patients (32.2%) experiencing TIA and 57 (44.9%) experienci
ng stroke reported symptoms to the study staff within 3 days of onset.
For TIA, there was a statistically significant inverse association be
tween prompt reporting and the amount of time a patient was enrolled i
n the study before the event occurred (48% with TIA occurring within 6
months vs 9% with TIA after year 3; P=.04). For stroke, there was a s
tatistically significant association between prompt reporting and trea
tment arm (56% for the surgical vs 38% for the medical group; P=.05).
For either TLA or stroke, none of the other factors examined were sign
ificantly associated with prompt reporting. Conclusions: Despite exten
sive education and reinforcement, fewer than 40% of all first events w
ere reported within 3 days and fewer than 25% were reported in less th
an 24 hours. Frequent outpatient evaluation of high-risk patients and
careful review of symptoms is necessary to determine when asymptomatic
carotid artery stenosis has become symptomatic to offer appropriate f
orms of therapy.