Incidence of Ischemic Stroke in Asymptomatic Severe Carotid Stenosis
- There is uncertainty about whether medical management or surgical intervention (carotid endarterectomy or carotid stenting) is superior for asymptomatic severe (70-99%) carotid stenosis.
- This uncertainty is driven in part by improved modern medical therapy, which may be associated with a lower rate of incident ischemic stroke from carotid disease when compared to older study data.
- The investigators of this retrospective study sought to define the risk of incident ischemic stroke among a more contemporary cohort of patients with asymptomatic severe carotid stenosis identified between 2008–2012.
- Among 3,737 patients with ≥1 severely stenosed asymptomatic carotid, the yearly risk of ipsilateral ischemic stroke was low, at about 1%.
What is the long-term risk of ipsilateral ischemic stroke among patients with severe asymptomatic carotid stenosis?
Patients included in this retrospective analysis had 70-99% stenosis of ≥1 carotid artery identified between 2008–2012 and had no history of transient ischemic attack (TIA)/stroke within the prior 6 months. If a patient had bilateral asymptomatic severe stenosis, each artery was evaluated independently. The primary outcome was acute ischemic stroke ipsilateral to the severely stenosed carotid.
A total of 4,230 arteries with asymptomatic severe stenosis in 3,737 patients were included in the final analysis: 133 (3.1%) carotid-related ischemic strokes occurred in 129 (3.5%) patients over 4.1 mean years of follow-up. The annual ipsilateral stroke rate was 0.9% (95% confidence interval, 0.7-1.2%).
In this retrospective study of patients with severely stenosed asymptomatic carotid stenosis without surgical intervention, the annual risk of ipsilateral stroke was about 1%.
It is uncertain whether medical management or surgical intervention (carotid endarterectomy or carotid stenting) is superior for patients with asymptomatic severe carotid stenosis. In this retrospective study, the yearly risk of carotid-related stroke among these patients was only about 1%. Given this low yearly risk, the complication rate of surgical intervention for asymptomatic disease would have to be extremely low to provide a favorable risk-benefit profile. The currently recruiting multicenter CREST-2 trial (NCT02089217), in which patients with asymptomatic severe carotid stenosis are randomized to medical therapy versus intervention, will help clarify the best approach for these patients.
Keywords: Asymptomatic Diseases, Brain Ischemia, Carotid Arteries, Carotid Stenosis, Constriction, Pathologic, Endarterectomy, Carotid, Ischemic Attack, Transient, Ischemic Stroke, Risk Factors, Secondary Prevention, Stroke, Vascular Diseases
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