Yang et al published on JAMA Neurology their retrospective analysis of patients
who presented at two atherosclerosis
clinics in Ontario with asymptomatic carotid artery stenoses
that were followed for 20-years with carotid duplex scans.
Among the 3681 patients who had annual
carotid ultrasound examinations, 316 (8.6%) were asymptomatic before an
occlusion that occurred during observation period.
Of the new occlusions, 254 of 316
[80.4%] occurred before 2002, when medical therapy was less intensive; the
frequency decreased by quartile of years (P < .001, χ2 test). Only 1 patient (0.3%) had a stroke at the time
of the occlusion, and only 3 patients (0.9%) had an ipsilateral stroke during
follow-up (all before 2005).
In Kaplan-Meier survival analyses,
neither severity of stenosis nor contralateral occlusion predicted the risk of
ipsilateral stroke or transient ischemic attack, death from stroke, or death from
unknown cause at a mean follow-up of 2.56 years. In Cox proportional hazards regression analyses, only age
(P = .02), sex (P = .01), and carotid plaque burden (P = .006) significantly predicted risk of those events.
The authors concluded that the risk
of progression to carotid occlusion is well below the risk of carotid stenting
or endarterectomy and has decreased markedly with more intensive medical
therapy. Preventing carotid occlusion is not a valid indication for intervention to prevent
occlusion as the circle of Willis offers substantial protection.
JAMA Neurol. 2015.1843
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