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Asymptomatic carotid stenosis: a benign lesion?
G D Shanik1, D J Moore, A Leahy
1Department of Vascular Surgery, St James' Hospital, Dublin, Ireland.
European Journal of Vascular Surgery
|January 1, 1992
Summary
This study followed 188 asymptomatic patients with carotid artery disease. A conservative approach is recommended, as the incidence of unheralded stroke remains low even with severe stenosis.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiology
Background:
- Asymptomatic carotid stenosis (ACS) risk assessment is challenging.
- Previous studies on ACS have been limited by patient selection and intervention bias.
Purpose of the Study:
- To determine the natural history of ACS in a randomly selected, unselected patient cohort.
- To evaluate the incidence of ischemic events (stroke, TIA) and death in patients with varying degrees of carotid stenosis.
Main Methods:
- Prospective follow-up of 188 asymptomatic patients with documented carotid artery disease.
- Carotid stenosis classified by duplex scanning.
- Patients were managed conservatively without intervention for up to 8 years.
Main Results:
- Patients with <50% stenosis: 3% died, 2% had stroke.
- Patients with 50-79% stenosis: 6% died, 4% had stroke, 2% had TIA.
- Patients with >80% stenosis: 7% had TIA, 7% had stroke, 2% died.
- No strokes occurred without a preceding TIA.
Conclusions:
- The incidence of unheralded stroke in ACS is low.
- A conservative management approach is recommended for asymptomatic carotid stenosis.
- Risk factors like hypertension and smoking are prevalent in this cohort.