Outcomes Following Carotid Revascularization for Stroke Stratified by Modified Rankin Scale and Time of Intervention

The relationship between baseline modified Rankin Scale (mRS) in patients with prior stroke and optimal timing of carotid revascularization is unclear. Therefore, we evaluated the timing of transfemoral carotid artery stenting (tfCAS), transcarotid artery stenting (TCAR), and carotid endarterectomy (CEA) after prior stroke, stratified by preoperative modified Rankin Scale (mRS). We identified patients with recent stroke who underwent tfCAS, TCAR, or CEA between 2012-2021. Patients were stratified by preoperative mRS (0-1, 2, 3-4, or 5) and days from symptom onset to intervention (time-to-intervention; ≤2 days, 3-14 days, 15-90 days, and 91-180 days). Firstly, we performed univariate analyses comparing in-hospital outcomes between separate mRS or time-to-intervention cohorts for all carotid intervention methods. Afterwards, multivariable logistic regression was used to adjust for demographics and comorbidities across groups, and outcomes between the various intervention methods were compared. Primary outcome was the in-hospital stroke/death rate. We identified 4260 patients who underwent tfCAS, 3130 patients who underwent TCAR, and 20,012 patients who underwent CEA. Patients were most likely to have minimal disability (mRS 0-1, 61%) and least likely to have severe disability (mRS 5, 1.5%). Patients most often underwent revascularization in 3-14 days (45%). Across all intervention methods, increasing preoperative mRS was associated with higher procedural in-hospital stroke/death (all, P