Timing of extracranial carotid revascularization following ischemic stroke or TIA: Outcomes of early carotid stenting in a cohort study

The optimal timing for carotid artery stenting (CAS) following ischemic stroke or transient ischemic attack (TIA) remains a matter of clinical controversy, particularly in Asian populations where data are limited. This study aimed to evaluate the safety and efficacy of early CAS in a high-risk Vietnamese cohort. We conducted a prospective observational study of 71 patients with symptomatic extracranial internal carotid artery stenosis who underwent CAS between January 2022 and December 2024. Eligible patients had either TIA or non-disabling ischemic stroke, and patients were categorized into early CAS (≤14 days from symptom onset) and delayed CAS (15–90 days). The primary outcome was the composite rate of stroke or death within 30 days. The mean age was 70.5 ± 8.6 years; 90.1% were male. A total of 42 patients underwent early CAS, and 29 underwent delayed CAS. The median time from index event to revascularization was 11 days, significantly shorter in the early group (7.5 days, interquartile range: 5–10) compared to the delayed group (30 days, interquartile range: 30–40) ( P  < .01). Overall, the 30-day stroke/death rate was 7.04%, the early and delayed CAS groups had comparable outcomes (7.14% vs 6.90%; P  = 1.00). Pre-CAS, 42.3% of patients experienced ≥1 ischemic event within 90 days, decreasing significantly to 7.0% in the 0 to 30 days post-CAS and 1.4% in the 31 to 90 days post-CAS ( P  < .001). Our findings suggest that early CAS after ischemic stroke and TIA may be feasible and safe, showing comparable short-term outcomes to delayed CAS.