Contemporary prevalence of carotid stenosis in patients presenting with ischaemic stroke
S F Cheng1, M M Brown2, R J Simister3
1Division of Surgery and Interventional Science, University College London, London, UK.
Insights
Carotid stenosis affects one in five stroke patients in the UK. Multidisciplinary team discussions are crucial for managing carotid stenosis and avoiding unnecessary interventions.
Area of Science:
- Neurology
- Vascular Medicine
- Public Health
Background:
- Carotid stenosis is a significant risk factor for ischaemic stroke and transient ischaemic attack (TIA).
- Recent years have seen a decline in interventions for carotid stenosis despite increasing awareness and stroke service centralization.
- This study aimed to assess the current prevalence and management strategies for carotid stenosis within the UK.
Purpose of the Study:
- To determine the prevalence of significant carotid stenosis (≥50%) in patients presenting with ischaemic stroke, TIA, or retinal artery occlusion.
- To evaluate the management and decision-making processes for patients with identified carotid stenosis.
- To understand the proportion of carotid stenosis cases that are symptomatic versus incidental.
Main Methods:
- A 1-year prospective observational study was conducted on consecutive patients admitted to a London hyperacute stroke unit.
- Significant carotid stenosis was defined as ≥50% atherosclerotic narrowing.
- Patients with significant stenosis underwent multidisciplinary team (MDT) discussion to determine stroke/TIA causality and stenosis classification.
Main Results:
- A total of 2707 patients were assessed, with 1252 undergoing carotid imaging.
- The prevalence of ≥50% carotid stenosis was 19.0%, identified in 238 patients.
- Carotid stenosis was symptomatic in 7.9% of patients; 58 were referred for intervention. Among asymptomatic cases, MDT discussion identified other causes for stroke in many patients.
Conclusions:
- Carotid stenosis is a common condition, present in approximately 19% of patients experiencing stroke or TIA.
- Multidisciplinary team (MDT) assessment is vital for appropriate patient management, potentially preventing unnecessary interventions.
- Establishing MDT discussion as the standard of care can optimize treatment strategies for carotid stenosis.
Background:
Carotid stenosis is a common cause of ischaemic stroke and transient ischaemic attack (TIA). Despite rising recognition and centralization of stroke services there has been a decline in interventions for carotid stenosis in recent years. The aim of this study was to determine the current prevalence and management of carotid stenosis in the UK.
Methods:
This was a 1-year prospective observational study of consecutive patients presenting with ischaemic stroke, TIA or ischaemic retinal artery occlusion to a central London hyperacute stroke unit. Patients with significant carotid stenosis, defined as atherosclerotic narrowing of 50 per cent or greater, underwent multidisciplinary team (MDT) discussion to determine the cause of stroke/TIA and classify carotid stenosis as symptomatic or incidental.
Results:
In total, 2707 patients were seen; half had an ischaemic event and the majority had carotid imaging (1252 of 1444). Carotid stenosis of at least 50 per cent was seen in 238 (prevalence 19·0 (95 per cent c.i. 16·6 to 21·4) per cent). Patients with significant carotid stenosis were more likely to have hypertension, hypercholesterolaemia, diabetes and ischaemic heart disease. Carotid stenosis was deemed symptomatic in 99 patients (7·9 (6·3 to 9·5) per cent); of these, 17 had carotid occlusion, 17 were unfit for surgery and 58 patients were referred for carotid intervention. Among 139 patients with asymptomatic stenosis, 75 had carotid stenosis ipsilateral to the stroke but, after MDT discussion, the cause was deemed to be atrial fibrillation (32), small-vessel disease (15), another determined cause (5), or not determined owing to atypical imaging or clinical presentation.
Conclusion:
Carotid stenosis is common, affecting one in five patients presenting with stroke or TIA. Careful MDT discussion may avoid unnecessary intervention and should be the standard of care.
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