The natural history of asymptomatic extracranial arterial disease

Area of Science:

• Vascular Surgery
• Neurology
• Cardiology

Background:

• Extracranial arterial disease poses a risk for cerebrovascular events.
• The natural history of asymptomatic patients with this condition requires further elucidation.

Purpose of the Study:

• To investigate the long-term outcomes of patients with untreated extracranial arterial disease and no neurological symptoms.
• To evaluate the stroke incidence and mortality in this cohort over a 10-year period.

Main Methods:

• A retrospective study of 76 patients with extracranial arterial disease diagnosed via angiography.
• Follow-up over 10 years to document mortality, cause of death, and cerebrovascular events.
• Analysis of stroke occurrence, transient ischemic attacks (TIAs), and their relationship to the original arterial lesion.

Main Results:

• Coronary artery disease was the leading cause of death (n=25).
• The overall cumulative stroke rate was 18%, three times higher than the general population.
• Only two strokes were directly related to the extracranial carotid lesion; most strokes occurred in different cerebrovascular territories.

Conclusions:

• Early carotid endarterectomy is not advisable for most asymptomatic patients with extracranial arterial disease.
• A strategy of regular non-invasive monitoring is favored to identify patients who would benefit from intervention at the optimal time.