title: Implications of the finding of no significant carotid stenosis based on data from a regional Australian vascular unit.
abstract: BACKGROUND
  The aim of this study was to assess the long-term clinical outcomes in terms of vascular events in patients who showed no significant or mild carotid stenosis (<50%) and thus in whom surgical intervention was not planned. Patients were recruited through referrals to a vascular laboratory between January 2000 and June 2000. One hundred thirty-two of 316 (42%) patients referred for carotid duplex scan were identified to have mild carotid artery disease.
  
  
  METHODS
  A retrospective observational study of patients identified to have mild carotid artery stenosis from a regional vascular unit in Australia was carried out. Patients were followed up over an 8-year period. Outcomes were assessed in relation to the patients' presenting complaint and risk factor profile. Outcomes included the following: (1) combined cardiovascular events (fatal and nonfatal strokes, fatal and nonfatal myocardial infarctions, and cardiac admissions, which included arrhythmias and angina), (2) strokes (both fatal and nonfatal strokes), and (3) all-cause mortality.
  
  
  RESULTS
  The patient sample included 75 men and 57 women. The median age of the patients was 69.9 (interquartile range: 63.4-76.7) years. There were a total of 49 vascular events in 46 of the 132 patients, including 16 nonfatal and 2 fatal myocardial infarctions, 19 admissions for cardiac reasons other than an acute coronary syndrome, and 12 nonfatal strokes. The cardiovascular and stroke rates were 33.9% and 13.0% at 7.7 years, respectively. The incidence of strokes was highest among those who presented with a previous stroke or a transient ischemic attack.
  
  
  CONCLUSIONS
  The long-term clinical outcomes of patients who were referred for duplex ultrasonography and found to have <50% stenosis were not benign. A significant number of vascular events were observed in this study group. Those who presented with a history of stroke or transient ischemic attack were at particular risk of another stroke.
authors.affiliation: Department of Medicine, Logan Hospital, School of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia. menaan@gmail.com
authors.forename: Dharmenaan
authors.initials: D
authors.lastname: Palamuthusingam
authors.forename: Frank
authors.initials: F
authors.lastname: Quigley
authors.forename: Jonathan
authors.initials: J
authors.lastname: Golledge
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality; D002561:Cerebrovascular Disorders / Q000209:etiology* / Q000401:mortality; D018450:Disease Progression; D005260:Female; D006331:Heart Diseases / Q000209:etiology* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011793:Queensland / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D019035:Rural Health Services; D012720:Severity of Illness Index; D013997:Time Factors; D018616:Ultrasonography, Doppler, Duplex