Asymptomatic Carotid Artery Stenosis and the Risk of Ischemic Stroke According to Subtype in Patients With Clinical Manifest Arterial Disease

Abstract

Background and Purpose-Because best medical treatment is improving, the risk of stroke in asymptomatic carotid artery stenosis (ACAS) may decline. We evaluated the risk of ischemic stroke and stratified it according to stroke subtype in patients with ACAS during long-term follow-up. Methods-In total, 4319 consecutive patients in the Second Manifestations of Arterial disease study with clinically manifest arterial disease or specific risk factors, but without a history of cerebrovascular disease, were included. Degree of stenosis was evaluated with duplex ultrasound scanning. Strokes during follow-up were classified according to subtype. Coxproportional hazard-regression models were used to evaluate the relationship between ACAS and future stroke. Results-We identified 293 (6.8%) patients with ACAS 50% to 99%, of whom 193 had 70% to 99% stenosis. In these subgroups, mean follow-up was 6.2 and 6.0 years, respectively. In total, 94 ischemic strokes occurred, of which 8 in ACAS 50% to 99% patients. The any territory annual ischemic stroke risk was 0.4% in 50% to 99% ACAS and 0.5% per year for 70% to 99% ACAS patients. The risk of ischemic stroke was not significantly increased in patients with ACAS 70% to 99% (hazard ratio, 1.5; 95% confidence interval, 0.7-3.5). Patients with ACAS 50% to 99% and ACAS 70% to 99% tended to have nonsignificantly more large vessel disease strokes (hazard ratio, 1.5; 95% confidence interval, 0.5-4.2 and hazard ratio, 1.7; 95% confidence interval, 0.5-5.6). Conclusions-Patients

Intervention versus Aggressive Medical Therapy for Cognition in Severe Asymptomatic Carotid Stenosis

“…[1][2][3][4] However, some of these patients carry a higher risk of stroke than others despite optimal medical treatment. Patients with detectable embolic signals by transcranial Doppler have a high annual risk (7%) of stroke.…”

Perfusion computed tomography: 4 cm versus 8 cm coverage size in subjects with chronic carotid artery stenosis

“…As a result, in all patients in the studied population, stenosis on the contralateral side was haemodynamically not significant (,50%). [14][15][16][17][18] Global perfusion parameters may be influenced by heart rate. For this reason, subjects with an abnormal heart rate and blood pressure were excluded from the study.…”

Carotid stenosis – basing treatment on individual patients’ needs. Optimal medical therapy alone or accompanied by stenting or endarterectomy

“…In contrast, for patients without a history of stroke or TIA who are on OMT of current standard, the annual risk of cerebral infarction is low (0.3-2.9 % [4][5][6][7]). A severe stenosis of ≥ 70 % might increase the annual risk for asymptomatic patients (ipsilateral neurologic symptoms 7.3-18.3 %; ipsilateral stroke 2.1-11.1 % [8,9].…”