You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better.


Advertisement

ABOUT ARCHIVES
Advanced Search

Welcome   | My Account | E-mail Alerts | RSS | Access Rights | Sign In


  Vol. 54 No. 10, October 1997 TABLE OF CONTENTS
  Online Only
 •  Online First Table of
Contents
  ORIGINAL CONTRIBUTIONS
 •Online Features
 This Article
 •References
 •Full text PDF
 • Reply to article
 •Send to a friend
 • Save in My Folder
 •Save to citation manager
 •Permissions
 Citing Articles
 •Citation map
 •Citing articles on HighWire
 •Citing articles on Web of Science (19)
 •Contact me when this article is cited
 Related Content
 •Similar articles in this journal
 Social Bookmarking
  Add to CiteULike Add to Connotea Add to Delicious Add to Digg Add to Facebook Add to Reddit Add to Technorati Add to Twitter What's this?

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

John E. Castaldo, MD; J. J. Nelson, PhD; James F. Reed III, PhD; Joan E. Longenecker, RN; James F. Toole, MD; Asymptomatic Carotid Atherosclerosis Study Investigators

Arch Neurol. 1997;54(10):1267-1271.


Abstract



Objective
To examine whether patients in the Asymptomatic Carotid Atherosclerosis Study reported symptoms of cerebral and retinal ischemia promptly to the investigating team.

Design
Cohort study within the Asymptomatic Carotid Atherosclerosis Study, a prospective, randomized, multicenter clinical trial, with a median follow-up time of 2.7 years.

Setting
Thirty-nine clinical sites across the United States and Canada.

Patients
Patients with asymptomatic carotid artery stenosis (≥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
Thirty-seven patients (32.2%) experiencing TIA and 57 (44.9%) experiencing stroke reported symptoms to the study staff within 3 days of onset. For TIA, there was a statistically significant inverse association between prompt reporting and the amount of time a patient was enrolled in 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 statistically significant association between prompt reporting and treatment arm (56% for the surgical vs 38% for the medical group; P=.05). For either TIA or stroke, none of the other factors examined were significantly associated with prompt reporting.

Conclusions
Despite extensive education and reinforcement, fewer than 40% of all first events were reported within 3 days and fewer than 25% were reported in less than 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 forms of therapy.



Author Affiliations



From the Departments of Medicine (Dr Castaldo), Community Health and Health Studies (Dr Reed), and Neurosciences Research (Ms Longenecker), Lehigh Valley Hospital, Allentown, Pa; the Department of Biostatistics, University of North Carolina, Chapel Hill (Dr Nelson); and the Department of Neurology, Bowman Gray School of Medicine, Winston-Salem, NC (Dr Toole).



Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Delicious Delicious   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Population-Based Study of Behavior Immediately After Transient Ischemic Attack and Minor Stroke in 1000 Consecutive Patients: Lessons for Public Education
Chandratheva et al.
Stroke 2010;41:1108-1114.
ABSTRACT | FULL TEXT  

Low Risk of Ipsilateral Stroke in Patients With Asymptomatic Carotid Stenosis on Best Medical Treatment: A Prospective, Population-Based Study
Marquardt et al.
Stroke 2010;41:e11-e17.
ABSTRACT | FULL TEXT  

A systematic review of delays in seeking medical attention after transient ischaemic attack
Sprigg et al.
J. Neurol. Neurosurg. Psychiatry 2009;80:871-875.
ABSTRACT | FULL TEXT  

Patient Behavior Immediately After Transient Ischemic Attack According to Clinical Characteristics, Perception of the Event, and Predicted Risk of Stroke
Giles et al.
Stroke 2006;37:1254-1260.
ABSTRACT | FULL TEXT  

Timing of TIAs preceding stroke: Time window for prevention is very short
Rothwell and Warlow
Neurology 2005;64:817-820.
ABSTRACT | FULL TEXT  

Editorial Comment--Transient Cerebral Ischemia Demands Urgent Evaluation
Graham
Stroke 2003;34:2451-2452.
FULL TEXT  

Very Early Risk of Stroke After a First Transient Ischemic Attack
Lovett et al.
Stroke 2003;34:e138-e140.
ABSTRACT | FULL TEXT  

Is Carotid Endarterectomy Appropiate for Asymptomatic Stenosis?: Yes
Castaldo
Arch Neurol 1999;56:877-879.
FULL TEXT  





HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | PHYSICIAN JOBS | SUBMIT | SUBSCRIBE | HELP
CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP
 
© 1997 American Medical Association. All Rights Reserved.