Prognosis of Asymptomatic Carotid Artery Occlusion: Systematic Review and Meta-Analysis. Issue 5 (May 2016)

• Record Type: Journal Article
• Authors: Hackam, Daniel G.
• Is Part Of: Stroke. Volume 47:Issue 5(2016)
• Publication Date: 2016-05
• Subjects: carotid artery diseases -- ischemic attack, transient -- prognosis -- publication bias -- risk; Cerebrovascular disease -- Periodicals; Cerebral circulation -- Periodicals; 616.81
• DOI: 10.1161/STROKEAHA.116.012760
• Languages: English
• ISSNs: 0039-2499

Abstract

Abstract : Background and Purpose—: The aim of this systematic review was to quantify the risk of ipsilateral stroke in patients with asymptomatic carotid artery occlusion (ACAO). Methods—: Studies reporting ipsilateral stroke risk in ACAO were identified by a search of MEDLINE, EMBASE, and study bibliographies. Study estimates were pooled using a random effects model, and heterogeneity was quantified using the I 2 statistic. The primary outcome was the annual rate of ipsilateral stroke. Results—: Thirteen studies were identified, encompassing 718 patients with ACAO who were followed up for a median of 2.8 years. The annual rate of ipsilateral stroke was 1.3% (95% confidence interval, 0.4–2.1; I 2 =53%). The annual rate of ipsilateral transient ischemic attack was 1.0% (95% confidence interval, 0.3–1.8; I 2 =40%). The annual rate of death was substantially higher at 7.7% (95% confidence interval, 4.3–11.2; I 2 =83%). Correction for possible publication bias for the primary outcome suggested a lower risk of ipsilateral stroke (0.3% per year; 95% confidence interval, –0.4 to 1.1). Conclusions—: Stroke in ACAO is relatively infrequent, but patients face high mortality rates. This suggests the need for intensified medical therapy in ACAO. Abstract : Supplemental Digital Content is available in the text.