Outcome of progression from carotid stenosis to occlusion

The incidence of symptoms at the moment the internal carotid artery (ICA) occludes was assessed in 33 patients. Duplex scanning was performed to determine the progression from stenosis to ICA occlusion. There were 24 patients with a primary stenosis and nine with a restenosis after a carotid endarterectomy. In 18% (6/33) the occlusion was accompanied by a stroke. A transient ischaemic attack (TIA) was seen in 12% (4/33) of patients and 70% (23/33) remained asymptomatic. There was no difference in stroke rate between patients with primary stenosis (4/24:17%) and those with restenosis (2/9:22%). The mean follow-up was 3.2 years and the mean elapse time to occlusion in patients with a stroke was 20 months, with a TIA, 32 months, and in asymptomatic patients, 44 months. It was also shown that a stenosis of greater than 80% diameter reduction had a faster progression (mean 1 year) than a less than 80% stenosis (mean 3.5 years) (p = 0.04). Patients with a stenosis greater than 80% tended to have a higher incidence (40%:2/5) of stroke at the time of occlusion than patients with a stenosis less than 80% (14%:2/28). The results show that an occlusion of the ICA is accompanied by a stroke in 18% of the cases and that patients with a rapid progression and/or greater than 80% stenosis are at high risk. From this point of view a carotid endarterectomy should be considered in order to prevent an occlusion of the ICA and a high risk of stroke.