Risk of Recurrent Stroke in Patients with Symptomatic Mild (20–49% NASCET) Carotid Artery Stenosis

Abstract

The present study on patients with symptomatic mild carotid artery stenosis, as determined by Doppler ultrasound, shows that there is still a substantial risk of recurrent stroke in this group.

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

“…Alternatively, mild and moderate CAS may be comparable risk factors of subclinical MI in the Asian population. Although previous studies have shown that the risk of MACE is related to the presence and severity of CAS 17 , there are very few reports available for Asians, and the association between asymptomatic mild CAS and MACE occurrence remains controversial 27 , 28 . The present study evaluated the impact of asymptomatic mild CAS on the subsequent occurrence of MACE in an Asian population and found that asymptomatic mild CAS and asymptomatic moderate CAS were comparable risk factors of subsequent MACE occurrence.…”

Editor's Choice – Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)

“…In a recent review of outcomes in previously symptomatic patients with 20e49% stenoses at baseline, the risk of recurrent ipsilateral stroke at 3 years was 7.4%. 254 In patients with <50% stenoses who report recurrent symptoms, it is important to ensure that medical treatment really has been optimised and that no other cause for the recurrent TIAs can be identified. If symptoms persist, despite optimal medical therapy, it may be reasonable to consider CEA/CAS, but this should not be undertaken without independent neurologist or stroke physician review.…”

Commentary on ‘Risk of Recurrent Stroke in Patients with Symptomatic Mild (20–49% NASCET) Carotid Stenosis’

“…The authors of this retrospective regional study report that patients with symptomatic mild carotid artery stenosis on current best medical management had a 7.4% cumulative incidence of recurrent ipsilateral stroke in 3-year follow-up. 1 This was a significantly higher risk of ipsilateral stroke than that of a comparable set of asymptomatic patients with similar mild carotid stenosis, as well as that of patients with symptomatic moderate or severe stenosis in the 3 years after CEA. If these results are supported by future studies, a prospective randomized trial is needed to determine whether CEA or current best medical therapy is recommended.…”