ArticleEuropean stroke journal2026
Short-term risk of recurrent stroke in symptomatic carotid near-occlusion: pooled analysis of three cohort studies.
Article in European stroke journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionCarotid near-occlusion (CNO) is a severe carotid stenosis causing distal internal carotid artery (ICA) diameter reduction, classifiable as with or without full collapse. Whether full collapse confers an especially high short-term recurrent stroke risk is debated, and no prior pooled analysis has quantified the ultra-early (0-2 day) risk. PATIENTS AND
methodsPooled individual patient data from 3 prospective cohort studies (TransAtlantic Carotid Near-Occlusion Study [TACNOS], UCC [Umeå Carotid Cohort], CAsi Oclusión Sintomática [CAOS]). The primary outcome was ipsilateral ischaemic stroke or retinal infarction within 90 days, censored at revascularisation. Full collapse was defined by visual appearance and by measurement (distal ICA ≤ 2.0 mm and/or ICA ratio ≤ 0.42). Cox regression and pre-specified sensitivity analyses addressing ascertainment bias and informative censoring were performed.
resultsA total of 360 patients with symptomatic CNO were included. The 90-day recurrent stroke risk was 16.4% (95% CI, 11.7%-21.1%), with 5.9% within the first 2 days. Per-cohort rates differed markedly (TACNOS 23.9%, UCC 22.3%, CAOS 8.1%; I2 = 77%, P = .012). By visual appearance (n = 333), 90-day stroke risk did not differ by collapse status (adjHR 1.5; 95% CI, 0.8-2.9). By measurement (n = 219), full collapse was associated with higher stroke risk (adjHR 2.0; 95% CI, 1.0-3.9). For both definitions, full collapse strongly predicted 0-2 day recurrence (adjHR 4.0; 95% CI, 1.5-10.5 and adjHR 4.8; 95% CI, 1.8-12.8). Full collapse combined with TIA identified a subgroup with 90-day stroke risk of 37.8% (by appearance) and 50.4% (by measurement). DISCUSSION: Findings should be interpreted in the context of substantial between-study heterogeneity and informative censoring; sensitivity analyses confirmed the robustness of the estimates.
conclusionsCarotid near-occlusion with full collapse carries a markedly elevated risk of stroke recurrence within 48 h, supporting dedicated trials of urgent revascularisation strategies. In exploratory analysis, presentation with TIA appeared to identify a particularly high-risk subgroup, a hypothesis-generating observation that requires independent validation.
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