Natural history of asymptomatic extracranial arterial disease. Results of a long-term prospective study.
The natural history of asymptomatic extracranial arterial disease (EAD) was studied prospectively in 339 patients admitted for serial ultrasound Doppler examinations. Annual mortality was high at 7%, but stroke mortality was low at 0.6%: 82 patients (24%) died during the follow-up period, which lasted up to seven years (median: 29 months), only 10 from stroke but 41 from cardiac causes. The risk of suffering a stroke without premonitory transient ischaemic attacks (TIAs) was similarly low at 0.4%. Progression of EAD was the only predictor established to indicate the individual patient's cerebrovascular prognosis among a series of criteria tested (age, sex, degree and extent of carotid and/or vertebral disease, risk factors and indicators of atherosclerosis). Deterioration of EAD was observed in 108 (36%) of 296 patients by repeated Doppler examination, 174 (59%) remained constant and 14 (5%) showed an improvement. The observed low rate of strokes without premonitory TIAs is not in favour for early carotid endarterectomy in the majority of neurologically asymptomatic patients.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001161:Arteriosclerosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D002340:Carotid Artery Diseases / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000401:mortality; D004691:Endarterectomy; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014465:Ultrasonics