Risk of major adverse cardiovascular events in subjects with asymptomatic mild carotid artery stenosis

Abstract

This study aimed to test the hypothesis that the risk of major adverse cardiovascular events (MACE) is similar for subjects with asymptomatic mild and moderate carotid artery stenosis (CAS). We enrolled a total of 453 subjects with asymptomatic CAS (30–69%) detected on baseline screening Doppler ultrasound (DUS) examination between January 2008 and December 2010. The follow-up DUS findings and MACE occurrence (fatal or nonfatal myocardial infarction or stroke and all-cause mortality) were compared between subjects with mild (30–49%) and moderate (50–69%) CAS during the 8-year follow-up period. There was no significant difference in the occurrence of MACE between subjects with mild (n = 289) and moderate (n = 164) CAS (13.8% vs. 15.9%, respectively; p = 0.56), although there was a nonsignificant trend toward an increased risk of major ipsilateral stroke in subjects with moderate CAS (1.4% vs. 4.3%; p = 0.06). Multivariate regression analysis indicated that worsening CAS was independently associated with MACE occurrence (hazard ratio [HR], 4.40; 95% confidence interval [CI], 2.65–7.27; p < 0.01), whereas an increased serum high-density lipoprotein cholesterol level was correlated with a decreased risk of MACE (HR, 0.42; 95% CI, 0.23–0.75; p < 0.01). The cumulative risk of MACE in subjects with asymptomatic mild CAS is similar to that in subjects with asymptomatic moderate CAS.

Effect of severe contralateral carotid stenosis or occlusion on early and late outcomes after carotid endarterectomy

“…All CEAs had been performed to relieve significant carotid bifurcation stenosis, as defined by velocity criteria, based on peak systolic velocity (PSV) and end-diastolic velocity values recorded from within the most stenotic segment. The diagnoses were also guided by criteria established by the North American Symptomatic Carotid Endarterectomy Trial (NASCET) [511].…”

“…Patients were considered to be symptomatic if they had transient ischemic attacks, amaurosis fugax, or non-disabling stroke ipsilateral to significant carotid stenosis within the previous 6 months [1213]. In cases of discrepancy in the degree of carotid stenosis determined using velocity criteria and luminal narrowing based on the NASCET criteria, the estimation of carotid stenosis was based primarily on the velocity criteria [11]. In patients with bilateral carotid bifurcation stenosis, the first side for operation (ipsilateral) was determined according to the following priority criteria: the presence of neurological symptoms, the degree of carotid stenosis, the presence of asymptomatic cerebral infarcts, and the dominant cerebral hemisphere [1214].…”

A low-cost machine learning-based cardiovascular/stroke risk assessment system: integration of conventional factors with image phenotypes

“…According to Boissel et al (19), surrogate markers should be (I) reproducible and convenient to compare with primary endpoints, (II) they must have a clear link with primary endpoints, and (III) they should provide clinically relevant benefits. Carotid artery stenosis is a well-established atherosclerosis-driven CV/stroke biomarker (10,16). It is generally accepted that the higher the luminal stenosis, the higher the risk of CV/ stroke events (17,20).…”

“…Even in the low-resolution images, CUS can capture the image-based phenotypes that reflect morphological variations in atherosclerotic plaque (4). Furthermore, the carotid ultrasound image-based phenotypes (CUSIP) such as carotid intima-media thickness (cIMT), carotid plaque (CP), and carotid artery stenosis are considered the most significant biomarkers of CV/stroke events (7)(8)(9)(10). Thus, integrating these CUSIP with CRF can convey a larger power of risk assessment (11)(12)(13).…”

“…Percentage stenosis is a clinically well-established biomarker which if left untreated may lead to CV/stroke events (10,16). Furthermore, percentage stenosis detected using CUS can assist physicians in making a judgment about stroke management practices such as endarterectomy or stenting (16)(17)(18).…”