[Evolution of symptomatic carotid stenoses under medical treatment]

Data from the 2 major studies (ECST and NASCET) carried out to evaluate surgery of symptomatic carotid artery stenosis provided more information on the evolution (during medical treatment) of these lesions than all previous work. The essential risk, that of a cerebral infarction homolateral to the stenosis, is closely related to the degree of stenosis; for occlusions greater than 70% it was 5% annually in the ECST and 13% in the NASCET, more severe occlusions being treated in the latter study. Inversely, it was only 0.5% annually for stenoses involving less than 30% (ECST). For occlusions of between 30 and 70%, the risk has not yet been determined exactly, since the 2 studies are ongoing, but everything suggests that the risk is related to the degree of stenosis for this range also. Factors increasing this risk include: the cerebral site--and not only retinal--of the initial stenosed carotid, the ulcerative nature of the stenosis, the existence of contralateral carotid occlusion and the presence of vascular risk factors. Therapy is dependent on the evaluation of total risk factors, surgery being indicated increasingly as there is the greater high risk of stenosis. Surgery is then additional to medical treatment of vascular risk factors, mainly hypertension and antithrombotic therapy: generally aspirin and perhaps Ticlopidine.