Abstract W P380: Asymptomatic Carotid Stenosis is Not a Walking Time Bomb
Background & Objective: Patients with asymptomatic carotid stenosis are often persuaded to have carotid stenting or endarterectomy on the grounds that they are “walking time bombs”, headed for disaster if the artery occludes. However, this approach ignores the protection afforded by the Circle of Willis. We therefore sought to determine the risk of stroke at the time of carotid occlusion, among patients being followed in a vascular prevention clinic.
Methods: Complete data were available in 386 asymptomatic patients who had a new carotid occlusion while being followed with annual carotid ultrasound examinations in our clinic. Mean followup after the occlusion was 3.42 ± 4.07 years. Percent stenosis was ≥ 80% in 60% and ≥ 90% in 53% of cases. Prior asymptomatic occlusion on the contralateral side was present in 11 cases. Mean age was 66.5 ± 10.7 years; 71.8% were male, 21% diabetic, and 24.4% still smoking prior to the occlusion.
Results: Only 1 patient (0.3%) had an ipsilateral stroke at the time of the new carotid occlusion. Percent stenosis did not predict a higher risk of any stroke/TIA/death during followup in Kaplan-Meier survival analysis ( Log rank p=0.60), nor did prior contralateral occlusion at the time of the index occlusion (p=1.0).
Conclusions: The risk of ipsilateral stroke at the time of carotid occlusion is well below the risk of either carotid stenting or carotid endarterectomy. Preventing carotid occlusion is not a valid indication for intervention, and percent stenosis or contralateral occlusion do not identify patients who would benefit from intervention. Patients with ACS should be treated with intensive medical therapy unless they have characteristics such as microemboli on transcranial Doppler, or other features of vulnerable plaque that identify them as high-risk.
Author Disclosures: C. Yang: None. C. Bogiatzi: None. J. Spence: None.
- © 2015 by American Heart Association, Inc.