Asymptomatic carotid stenosis: a benign lesion?
Recent reports of the risk of asymptomatic carotid stenosis have been compromised by flawed patient selection or the performance of a large number of carotid endarterectomies during follow-up. We report the natural history of a randomly selected group of asymptomatic patients (n = 188; 114 males and 74 females) with documented carotid artery disease who were prospectively followed without intervention for up to 8 years. Risk factors included ischaemic heart disease in 17%, diabetes in 10%, hypertension in 46% and 88% were smokers. The degree of internal carotid stenosis was classified by duplex scanning and a total of 259 vessels had evidence of atherosclerosis. Study end-points included TIA, CVA and death. At mean follow-up of 4 years 3% of the 96 patients with internal carotid artery stenosis of less than 50% had died and 2% suffered a stroke. Six per cent of patients with a stenosis of 50-79% had died and 4% and 2% had suffered a CVA and TIA, respectively. In the 59 patients with greater than 80% stenosis 7% had suffered a TIA and an additional 7% a CVA, while 2% had died. None of the patients suffering a stroke had an antecedent TIA. Though the incidence of ischaemic events is significantly higher in patients with greater than 80% stenosis the incidence of unheralded stroke remains low. We therefore continue to recommend a conservative approach to the management of asymptomatic carotid stenosis.
Shanik
G D
GD
Department of Vascular Surgery, St James' Hospital, Dublin, Ireland.
Moore
D J
DJ
Leahy
A
A
Grouden
M C
MC
Colgan
M P
MP
D000368:Aged; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000401:mortality*; D002423:Cause of Death; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000401:mortality; D004453:Echoencephalography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000000981:diagnostic imaging / Q000401:mortality; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000401:mortality; D008297:Male; D012307:Risk Factors; D015996:Survival Rate