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A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis
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Effects of intensive medical therapy on microemboli and cardiovascular risk in asymptomatic carotid stenosis

J David Spence1, Victoria Coates, Hector Li

  • 1Stroke Prevention and Atherosclerosis Research Centre, 1400 Western Road, London, Ontario, Canada. dspence@robarts.ca

Archives of Neurology
|December 17, 2009
PubMed

Insights

Intensive medical therapy significantly reduced microemboli and cardiovascular events in patients with asymptomatic carotid stenosis (ACS). Revascularization is now less beneficial, with intensive medical management being the primary recommendation.

Area of Science:

  • Vascular Medicine
  • Neurology
  • Cardiology

Background:

  • Asymptomatic carotid stenosis (ACS) poses a risk for stroke.
  • Transcranial Doppler (TCD) can detect microemboli, indicators of embolic risk.
  • Previous management strategies for ACS focused on revascularization.

Purpose of the Study:

  • To evaluate the impact of intensified medical therapy on TCD microemboli and cardiovascular events in ACS patients.
  • To compare outcomes before and after the implementation of more intensive medical protocols since 2003.

Main Methods:

  • Prospective study conducted at a teaching hospital.
  • Included 468 patients with ACS (>60% stenosis).
  • Compared microemboli on TCD, cardiovascular events, and carotid plaque progression rates before and after 2003.

Main Results:

  • Microemboli decreased from 12.6% to 3.7% (P < .001) post-2003, correlating with better lipid control and slower plaque progression.
  • Cardiovascular events (stroke, MI, death, symptomatic endarterectomy) dropped from 17.6% to 5.6% (P < .001).
  • First-year carotid plaque progression rate significantly reduced from 69 mm² to 23 mm² (P < .001).

Conclusions:

  • Intensified medical therapy markedly reduces cardiovascular events and microemboli in ACS patients.
  • Less than 5% of ACS patients may benefit from revascularization.
  • Primary recommendation for ACS patients is intensive medical therapy, with revascularization considered only if microemboli are present on TCD.
Abstract

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