CASCOM Study: CAR Score Predicting Restroke in Symptomatic Carotid Stenosis With Only Intensive Medical Therapy

Area of Science:

• Neurology
• Vascular Medicine
• Clinical Trials

Background:

• Carotid endarterectomy decisions rely on outdated trials, while medical treatments have advanced.
• The Carotid Artery Risk (CAR) score aids in predicting stroke risk.
• This study examines stroke risk in patients with symptomatic carotid stenosis managed with modern medical therapy.

Purpose of the Study:

• To evaluate the 2-year risk of recurrent ipsilateral stroke.
• To assess the effectiveness of intensive medical therapy in patients with symptomatic carotid stenosis.
• To determine the predictive value of the CAR score in this patient group.

Main Methods:

• Prospective, single-arm observational study in Denmark (Oct 2020-Mar 2023).
• 109 patients with recent TIA, amaurosis fugax, or minor stroke and 50-99% ipsilateral carotid stenosis were enrolled.
• All patients received intensive medical therapy; primary outcome was ipsilateral stroke or death within 2 years.

Main Results:

• 5.5% of patients experienced ipsilateral recurrent stroke, a ~75% reduction compared to historical rates.
• Patients with a CAR score ≤20% had a significantly lower 2-year stroke rate (3.1%) than those with CAR score >20% (23%).
• The CAR score ≤20% subgroup demonstrated high predictive accuracy (sensitivity 0.90, specificity 0.50, PPV 0.97).

Conclusions:

• Modern medical therapy is linked to low recurrent stroke rates in symptomatic carotid stenosis.
• A CAR score ≤20% indicates a low risk of recurrent stroke.
• Selected patients with symptomatic carotid stenosis may be effectively managed conservatively.