Ischemic Stroke in Asymptomatic Severe Carotid Stenosis Patients

For a study, researchers sought to assess stroke outcomes in individuals with asymptomatic severe carotid stenosis who were not surgically treated. Retrospective cohort research with 3,737 adult individuals with asymptomatic severe (70%-99%) carotid stenosis detected between 2008 and 2012 with no prior intervention or ipsilateral neurologic incident in the previous 6 months. Participants were all members of an integrated US regional health system covering 4.5 million people and were followed up on until 2019. Acute ischemic stroke is caused by an ipsilateral carotid artery. Censorship took place as a result of death, disenrollment, or ipsilateral intervention. 

About 4,230 arteries in 3,737 patients (mean age, 73.8 [SD 9.5 years]; 57.4% male) satisfied selection criteria among 94,822 individuals having qualifying imaging data, including 2,539 arteries in 2,314 patients who never had an intervention. This sample’s average follow-up length was 4.1 years (SD 3.6 years). There were 133 ipsilateral strokes prior to any intervention, with a mean yearly stroke rate of 0.9% (95% CI, 0.7% -1.2%). By 5 years, the Kaplan-Meier estimate of ipsilateral stroke was 4.7% (95% CI, 3.9% -5.7%).

Over 5 years, the estimated risk of ipsilateral carotid-related acute ischemic stroke in a community-based cohort of individuals with asymptomatic severe carotid stenosis who did not seek surgical intervention was 4.7%. The findings might help guide surgical and medicinal therapy decisions for individuals with asymptomatic severe carotid artery stenosis.

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