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Are strokes predictable with noninvasive methods: a five-year follow-up of 303 unoperated patients
Insights
Internal carotid artery stenosis greater than or equal to 50% significantly correlates with increased stroke risk. Even lesser stenosis degrees do not exclude future neurologic events or cardiac risks.
Area of Science:
- Neurology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Cerebrovascular disease poses a significant health risk.
- Noninvasive tests are crucial for evaluating arterial stenosis.
- Understanding stenosis severity and stroke risk is vital for patient management.
Purpose of the Study:
- To correlate internal carotid arterial stenosis severity with subsequent stroke risk.
- To assess stroke risk in patients with varying degrees of stenosis.
- To evaluate cardiac mortality risk in relation to stenosis.
Main Methods:
- Retrospective review of 303 patients undergoing cerebrovascular evaluation.
- Utilized the Hokanson ultrasonic arteriograph for stenosis assessment.
- Followed 90% of patients for 5 years or until death.
Main Results:
- A significant correlation (p=0.04) was found between stenosis severity and stroke incidence.
- Stroke risk was 19% for >=50% stenosis, 11% for 0-49% stenosis, and 10% for no stenosis.
- Patients with >=50% stenosis had doubled risk of cardiac death; stroke risk increased after 2 years for <50% stenosis.
Conclusions:
- Hemodynamically significant internal carotid artery stenosis identifies patients at higher risk of stroke and myocardial infarction.
- Lesser degrees of stenosis do not preclude future neurologic events.
- Noninvasive evaluation aids in risk stratification for cerebrovascular and cardiovascular events.
Abstract:
To determine the correlation between the degree of internal carotid arterial stenosis demonstrated by noninvasive tests and the risk of subsequent stroke, 303 consecutive patients who underwent cerebrovascular evaluation with the Hokanson ultrasonic arteriograph were reviewed retrospectively. Ninety percent of the patients were followed up for 5 years or until the time of death. Stroke occurred in 41 (13.5%) patients. There was a significant correlation (p = 0.04) between the incidence of stroke and severity of disease: greater than or equal to 50% stenosis (19%), 0% to 49% stenosis (11%), and no stenosis (10%). Stroke as a presenting complaint carried the highest risk of subsequent neurologic defect (24%), but the risk in patients without symptoms was appreciable (15%). Life-table analysis indicated that the incidence of stroke was low (less than 3%) in the asymptomatic and nonhemispheric group during the first 2 years after evaluation when the degree of stenosis was less than 50%. Thereafter, the stroke rate increased. Half the deaths were due to myocardial infarction; the risk of death from cardiac causes was doubled in patients with greater than 50% stenosis. It is concluded that the demonstration of hemodynamically significant stenosis does select a group of patients at increased risk for subsequent stroke and myocardial infarction, but lesser degrees of stenosis do not exclude future neurologic events.