Asymptomatic carotid stenosis in patients on medical treatment alone.
OBJECTIVE
the aim of this study was to investigate the effect of currently recommended medical treatment (MT) on changes in carotid stenosis in a group of asymptomatic patients taken from the Asymptomatic Carotid Surgery Trial (ACST).


METHODS
collaborators in ACST were given information on MT for stroke prevention (including antiplatelet agents, lipid-lowering drugs, diabetic and hypertension control). Patients underwent clinical examination and duplex scanning at entry, 4 months following randomisation and annually thereafter. The cohort of patients studied were those randomised to MT with complete follow up duplex datasets at four years (n=219). None had undergone carotid endarterectomy (CEA) or developed ipsilateral carotid symptoms.


RESULTS
there was no change in median carotid stenosis over four years (baseline 79% (IQR 10%) and 4 year median 79% (IQR 10%)) a median difference of 0 with Q1=-5 and Q3=+5 (p=0.98 Wilcoxon one sample test), whilst in many patients' stenoses progressed and regressed during this time. No individual MT variable correlated with stenosis progression or regression.


CONCLUSIONS
in this group of ACST patients on MT, mean carotid stenosis was unchanged over 4 years. Individual patients' stenoses progressed (and regressed) without symptoms occurring. An increase in stenosis should not be the sole basis for deciding to operate on an asymptomatic patient.
Sleight
S P
SP
St George's Hospital Medical School, London, U.K.
Poloniecki
J
J
Halliday
A W
AW
D000368:Aged; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex