Natural History of Non-operative Management in Asymptomatic Patients with 70%–80% Internal Carotid Artery Stenosis by Duplex Criteria

Autor: Robert T. Eberhardt, Denis Rybin, Mallika Gopal, Alik Farber, Douglas W. Jones, Thomas W. Cheng, Jeffrey J. Siracuse, Jeffrey A. Kalish, Mohammad H. Eslami, Keyona E. Pointer
Rok vydání: 2020
Předmět:
Male
medicine.medical_specialty
Time Factors
medicine.medical_treatment
Carotid endarterectomy
030204 cardiovascular system & hematology
030230 surgery
Severity of Illness Index
Asymptomatic
End stage renal disease
03 medical and health sciences
0302 clinical medicine
Predictive Value of Tests
Risk Factors
medicine.artery
Internal medicine
medicine
Humans
Carotid Stenosis
cardiovascular diseases
Common carotid artery
Aged
Retrospective Studies
Aged
80 and over
Ultrasonography
Doppler
Duplex
business.industry
Hazard ratio
Atrial fibrillation
medicine.disease
Stroke
Stenosis
Treatment Outcome
Ischemic Attack
Transient
Asymptomatic Diseases
Disease Progression
Cardiology
Female
Surgery
medicine.symptom
Internal carotid artery
Cardiology and Cardiovascular Medicine
business
Carotid Artery
Internal
Zdroj: European Journal of Vascular and Endovascular Surgery. 60:339-346
ISSN: 1078-5884
Popis: Treatment of asymptomatic internal carotid artery (ICA) stenosis, particularly for moderate to severe (70%-80%) disease, is controversial. The goal was to assess the clinical course of patients with moderate to severe carotid stenosis.A single institution retrospective analysis of patients with asymptomatic ICA stenosis identified on duplex ultrasound as moderate to severe (70%-80%) from 2003 to 2018 were analysed. Duplex criteria for 70%-80% stenosis was a systolic velocity of ≥325 cm/s or an ICA:common carotid artery ratio of ≥4, and an end diastolic velocity of140 cm/s. Asymptomatic status was defined as no stroke/transient ischaemic attack (TIA) within six months of index duplex. Primary outcomes were progression of stenosis to80%, ipsilateral stroke/TIA without documented progression, and death.In total, 206 carotid arteries were identified in 182 patients meeting the inclusion criteria. Mean patient age was 71.5 years, 57.7% were male, and 67% were white. There were 19 stenoses removed from analysis except for survival analysis as they initially underwent carotid endarterectomy or carotid artery stent based on surgeon/patient preference. Documented progression occurred in 24.1% of stenoses. There were 5.3% of stenoses associated with an ipsilateral stroke/TIA without documented progression, which occurred at a mean of 26.4 months. Kaplan-Meier analysis demonstrated a 60.3% five year freedom from stenosis progression, 92.5% five year freedom from stroke/TIA without documented progression, and 83.7% five year survival. Risk factors associated with stroke/TIA without documented progression at five years were atrial fibrillation (hazard ratio [HR] 14.87, 95% confidence interval [CI] 2.72-81.16; p = .002) and clopidogrel use at index duplex (HR 6.19, 95% CI 1.33-28.83; p = .020). Risk factors associated with death at five years were end stage renal disease (HR 9.67, 95% CI 2.05-45.6; p = .004), atrial fibrillation (HR 7.55, 95% CI 2.48-23; p .001), prior head/neck radiation (HR 6.37, 95% CI 1.39-29.31; p = .017), non-obese patients (HR 5.49, 95% CI 1.52-20; p = .009), and non-aspirin use at index duplex (HR 3.05, 95% CI 1.12-8.33; p = .030).Patients with asymptomatic moderate to severe carotid stenosis had a low rate of stroke/TIA without documented progression. However, there was a high rate of stenosis progression reinforcing the need to follow these patients closely.
Databáze: OpenAIRE
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