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Prognosis of asymptomatic ulcerating carotid lesions
Insights
For patients with asymptomatic carotid bifurcation ulcerated plaque, the seven-year stroke rate is only 1%. Prophylactic carotid endarterectomy is not recommended due to the low risk of stroke.
Area of Science:
- Vascular Surgery
- Cerebrovascular Disease
- Neurology
Background:
- Ulcerated plaque in the carotid bifurcation is a potential source of cerebrovascular events.
- The optimal management strategy for asymptomatic ulcerated plaque remains debated.
- Understanding the natural history and stroke risk is crucial for clinical decision-making.
Purpose of the Study:
- To evaluate the long-term stroke risk associated with asymptomatic carotid bifurcation ulcerated plaque (UP).
- To determine if prophylactic carotid endarterectomy is warranted for these lesions.
Main Methods:
- Angiographic identification of 91 asymptomatic UPs in 79 patients.
- Life-table analysis for cumulative stroke and mortality rates over a mean follow-up of three years (with 96% follow-up).
- Subgroup analysis comparing small and large UPs, and assessment of transient ischemic attacks (TIAs) and stroke incidence.
Main Results:
- The cumulative stroke rate at seven years was low, at 1%.
- Small UPs (n=63) had a 7% cumulative symptom rate (3 TIAs, 1 stroke).
- Large UPs (n=24) had a 9% TIA rate with no observed strokes. Cumulative mortality was 17% at 3 years and 52% at 7 years.
Conclusions:
- Asymptomatic carotid bifurcation ulcerated plaque carries a low seven-year stroke risk of 1%.
- No significant differences in stroke rate or mortality were observed between subgroups.
- Prophylactic carotid endarterectomy is not justified for asymptomatic carotid bifurcation ulcerations based on these findings.
Abstract:
To determine the proper approach to asymptomatic carotid bifurcation ulcerated plaque (UP), 79 patients with 91 asymptomatic UPs were identified angiographically, and a 96% follow-up was obtained with a mean duration of three years. The cumulative stroke rate by life-table analysis was 1% at seven years. Sixty-three UPs in 55 patients were classified as small, and of these patients, transient ischemic attacks (TIAs) that were appropriate to the lesion developed in three and stroke in one (7% cumulative symptom rate). Twenty-four UPs in 21 patients were classified as large, and a TIA developed in one patient (9%), but no strokes were observed in this group. The cumulative mortality was 17% at three years and 52% at seven years. Life-table curves of several subgroups were compared and showed no significant differences in either stroke rate or mortality between any of these groups. On the basis of these data, and particularly the seven-year stroke rate of 1%, prophylactic carotid endarterectomy is not justified for asymptomatic carotid bifurcation ulcerations.