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Asymptomatic carotid disease: changing perspectives

D S Adams1

  • 1Tulane University School of Medicine.

The Journal of the Louisiana State Medical Society : Official Organ of the Louisiana State Medical Society
|May 1, 1994
PubMed
Summary
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Recent findings clarify carotid stenosis risks, indicating bruits pose low stroke risk. Severe stenosis (>70%) has a 3% annual stroke risk, and prophylactic surgery for asymptomatic carotid stenosis shows no proven benefit.

Area of Science:

  • Neurology
  • Vascular Surgery
  • Public Health

Background:

  • Recent data have improved understanding of carotid stenosis risks and stroke etiology.
  • Cervical bruits are associated with a minimal stroke risk.
  • Severe carotid stenosis (>70%) is uncommon in the general population, conferring a 3% annual stroke risk.

Purpose of the Study:

  • To review the current understanding of carotid stenosis and stroke risk.
  • To evaluate the efficacy and safety of surgical intervention for asymptomatic carotid stenosis.

Main Methods:

  • Literature review of studies published in the last decade.
  • Analysis of stroke risk associated with carotid stenosis severity.
  • Assessment of surgical outcomes and risks for carotid endarterectomy.

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Main Results:

  • Only 15% of strokes are attributable to surgically accessible carotid disease.
  • Prophylactic carotid endarterectomy has not demonstrated significant benefit.
  • Surgery for asymptomatic carotid stenosis carries an acceptable risk of no more than 3%.

Conclusions:

  • The optimal management strategy for carotid stenosis remains undetermined.
  • Surgery for asymptomatic carotid stenosis must achieve very low risk to be beneficial.
  • Current evidence does not support surgical intervention improving the natural history of asymptomatic carotid stenosis.