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Prognosis of asymptomatic carotid occlusion
W Rautenberg1, W Mess, M Hennerici
1Department of Neurology, Klinikum Mannheim, University of Heidelberg, F.R.G.
Insights
Patients with internal carotid artery occlusion face significant stroke and TIA risks. Early intervention for progressive carotid stenosis may be beneficial due to ongoing risks even after occlusion.
Area of Science:
- Neurology
- Vascular Surgery
- Cardiovascular Medicine
Background:
- Internal carotid artery occlusion (ICAO) is a significant risk factor for cerebrovascular events.
- Asymptomatic patients with ICAO require careful monitoring and risk stratification.
- Progressive extracranial arterial disease can lead to occlusion, posing distinct clinical challenges.
Purpose of the Study:
- To evaluate the long-term risk of stroke and transient ischemic attacks (TIA) in asymptomatic patients with internal carotid artery occlusion.
- To compare stroke and TIA rates in patients with progressive extracranial arterial disease versus those with established occlusion.
- To assess the implications for treatment strategies, including carotid endarterectomy, in pre-occlusive states.
Main Methods:
- Prospective follow-up of 94 asymptomatic patients with ICAO for a mean of 44 months.
- Analysis of stroke, TIA, and mortality rates in the ICAO cohort.
- Evaluation of 27 asymptomatic patients with progression of extracranial arterial disease to occlusion, monitoring for stroke and TIA events.
Main Results:
- In the ICAO cohort, 16% experienced strokes and 11.7% had TIAs over the follow-up period, with annual rates of 4.4% for stroke and 3.2% for TIA.
- Annual mortality in the ICAO group was 11.3%.
- In the subgroup with progressive disease to occlusion, annual stroke rate was 1.9% and TIA rate was 4.7%, indicating a higher TIA risk compared to established occlusion.
Conclusions:
- Internal carotid artery occlusion is associated with substantial risks of stroke and TIA.
- Progressive high-degree carotid stenosis carries an increased risk that persists after occlusion.
- These findings suggest that carotid endarterectomy may be a valuable option for selected patients with significant pre-occlusive stenosis, as medical management has not proven effective in preventing progression to occlusion.
Abstract:
Ninety-four asymptomatic patients with internal carotid artery occlusion were followed for a mean of 44 months, 16% suffered strokes and 11.7% reported transient ischemic attacks (TIA). The annual stroke and TIA rates were 4.4% and 3.2%, respectively, the annual mortality was 11.3%. In 27 asymptomatic patients progression of extracranial arterial disease to occlusion was observed: 7.4% of these patients suffered from stroke and 18.5% reported TIA's during that period. Thus the annual stroke rate was lower (1.9%) but the TIA rate higher (4.7%) than post-occlusive rates. These data reflect an increase risk in patients with progressive high-degree carotid stenosis which continues after occlusion. This may favour carotid endarterectomy for selected patients in the pre-occlusive state because medical treatment has not been shown to prevent progression of stenosis to occlusion.