title: Symptomatic carotid near-occlusion with full collapse might cause a very high risk of stroke.
abstract: BACKGROUND
  The risk of early stroke recurrence amongst patients with symptomatic carotid near-occlusion with and without full collapse is unknown. Therefore, the aim of this study was to analyse the 90-day risk of recurrent ipsilateral ischaemic stroke in patients with symptomatic carotid near-occlusion both with and without full collapse.
  
  
  METHODS
  This study was a secondary analysis of the Additional Neurological SYmptoms before Surgery of the Carotid Arteries: a Prospective study (ANSYSCAP). We prospectively analysed 230 consecutive patients with symptomatic 50-99% carotid stenosis or near-occlusion. Based on the combination of several imaging modalities, 205 (89%) patients were classified as having 50-99% carotid stenosis, and 10 (4%) and 15 (7%) as having near-occlusion with and without full collapse, respectively. The 90-day risk of recurrent ipsilateral ischaemic stroke was compared between these three groups. Only events that occurred before carotid endarterectomy were analysed.
  
  
  RESULTS
  The 90-day risk of recurrent stroke was 18% [95% confidence interval (CI) 12-25%; n = 29] for patients with 50-99% carotid stenosis, 0% for patients with near-occlusion without full collapse and 43% (95% CI 25-89%; n = 4) for patients with near-occlusion with full collapse (P = 0.035, log-rank test). The increased risk of recurrent ipsilateral ischaemic stroke for patients with symptomatic near-occlusion with full collapse remained significant after multivariable adjustment for age, sex and type of presenting event.
  
  
  CONCLUSIONS
  Patients with symptomatic carotid near-occlusion with full collapse might have a very high risk of stroke recurrence. Carotid endarterectomy could be considered for these patients.
authors.affiliation: Department of Pharmacology and Clinical Neuroscience and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Johansson
authors.forename: K
authors.initials: K
authors.lastname: Öhman
authors.forename: P
authors.initials: P
authors.lastname: Wester
mesh_terms: D000368:Aged; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
keywords: CEA; carotid near-occlusion; carotid stenosis; risk; stroke