title: Risk of Recurrent Stroke in Patients with Symptomatic Mild (20-49% NASCET) Carotid Artery Stenosis.
abstract: The objective of this study was to evaluate the risk of recurrent ischaemic stroke in patients with ultrasound assessed symptomatic mild carotid artery stenosis (20-49% NASCET) treated solely with modern medical treatment.
  
  
  
  This was a retrospective, observational register cohort study. Three groups of patients were recruited from a database of all carotid Doppler ultrasound examinations performed in the Gothenburg region between 2004 and 2009. Patients with symptomatic mild carotid artery stenosis (n = 162) were compared with patients with asymptomatic carotid artery stenosis (n = 301) of equal degree and a group of patients with surgically (CEA) treated symptomatic moderate or severe carotid artery stenosis (n = 220). Kaplan-Meier estimates and Cox proportional hazard models were used to compare the primary outcome (ipsilateral ischaemic stroke) between groups.
  
  
  
  After a 3 year follow up, the cumulative incidence of recurrent ipsilateral stroke in patients with symptomatic mild carotid artery stenosis was 7.4%. Patients with symptomatic mild carotid artery stenosis had a substantially increased risk of recurrent ipsilateral stroke compared with asymptomatic patients with equal degree of stenosis (HR 5.5. 95% CI 1.8-17.1; p = .003) as also compared with patients with CEA treated symptomatic moderate or severe stenosis (HR 7.8. 95% CI 1.62-37.8; p = .011).
  
  
  
  The present study on patients with symptomatic mild carotid artery stenosis, as determined by Doppler ultrasound, shows that there is still a substantial risk of recurrent stroke in this group.
authors.affiliation: The Wallenberg Laboratory for Cardiovascular Research, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Clinical Physiology, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden. Electronic address: Lena.karlsson@gu.se.
authors.forename: L
authors.initials: L
authors.lastname: Karlsson
authors.affiliation: The Wallenberg Laboratory for Cardiovascular Research, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Kangefjärd
authors.affiliation: The Wallenberg Laboratory for Cardiovascular Research, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Clinical Physiology, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Hermansson
authors.affiliation: The Wallenberg Laboratory for Cardiovascular Research, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Vascular Surgery, Institute of Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Strömberg
authors.affiliation: The Wallenberg Laboratory for Cardiovascular Research, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Vascular Surgery, Institute of Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Österberg
authors.affiliation: Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Nordanstig
authors.affiliation: The Wallenberg Laboratory for Cardiovascular Research, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Ryndel
authors.affiliation: The Wallenberg Laboratory for Cardiovascular Research, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Gellerman
authors.affiliation: Department of Clinical Physiology, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Fredén-Lindqvist
authors.affiliation: The Wallenberg Laboratory for Cardiovascular Research, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Clinical Physiology, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: G M L
authors.initials: GM
authors.lastname: Bergström
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000209:etiology; D016893:Carotid Stenosis / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology*; D017585:Ultrasonography, Doppler, Transcranial
keywords: Carotid artery stenosis; Mild; Recurrent stroke; Symptomatic