The fate of asymptomatic severe carotid stenosis in the era of best medical therapy. (6th December 2017)

• Record Type: Journal Article
• Authors: Pini, Rodolfo; Faggioli, Gianluca; Vacirca, Andrea; Cacioppa, Laura Maria; Gallitto, Enrico; Gargiulo, Mauro; Stella, Andrea
• Is Part Of: Brain injury. Volume 31:Number 13/14(2017)
• Page Start: 1711
• Page End: 1717
• Publication Date: 2017-12-06
• Subjects: Asymptomatic carotid artery stenosis -- best medical therapy -- follow-up; Brain damage -- Periodicals; Brain -- Wounds and injuries -- Periodicals; Brain Injuries -- Periodicals; 617.481
• DOI: 10.1080/02699052.2017.1346285
• Languages: English
• ISSNs: 0269-9052

Abstract

ABSTRACT: Background : Medical therapy for asymptomatic carotid artery stenosis (ACAS) may obviate the carotid revascularization, according to recent literature reports, but many studies also considered moderate carotid artery stenosis (50–69% NASCET). This study reviews the most recent series of ACAS focusing on ipsilateral transient ischemic attack (TIA) stroke and annual risk of stroke in patients with ACAS ≥70%, thereby also evaluating the adherence to best medical therapy (BMT). Methods : A systematic review consisting of all the series of patients with ACAS being treated medically was performed, which was published after 2005. The annual pooled risk of ipsilateral TIA-stroke and stroke in patients with ACAS ≥70% was calculated. A subgroup of studies with BMT defined as ≥90% of the patients in antiplatelet and statin therapy was performed. Results : Eleven studies, with the enrolling period from 1996 to 2009, were reviewed. Overall, 2185 patients were considered, with a follow-up from 2 to 13 years, for a total of 6834 patients/year. The pooled risk was 3.4%/year for ipsilateral TIA-stroke and 1.6%/year for stroke. Five studies, published from 2014, had BMT adherence, for a total of 1665 patients/year. The pooled risk was 3.5%/year for ipsilateral TIA-stroke and for stroke. Conclusion : The most recent series of ACAS ≥70% and BMT had an overall stroke rate which is relatively low; however, the risk of developing symptoms is still relevant (3.4%/year).