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Carotid artery occlusion is a risk factor for stroke ipsilateral to the occlusion and puts patients in a high risk category when contralateral endarterectomy is performed. The purpose of this study was to evaluate the long-term outcomes of patients with internal carotid artery occlusion and to determine risk factors predictive of subsequent neurological event, contralateral carotid intervention, or death. Patients with internal carotid artery occlusion shown by duplex ultrasound were retrospectively identified and followed between January 2002 and June 2010 (follow-up 1 to 101 months, mean 52 months) at a tertiary care hospital. All had multiple duplex exams available for review. Chi-square analysis was used to determine risk factors for neurologic event, contralateral intervention, or all cause morality. Multivariate Cox proportional hazard analysis was conducted using univariate risk factors with P values (<.1). Survival was estimated using the Kaplan-Meier method (p<.05 significant). 80 patients with internal carotid artery occlusion were identified and available for analysis. On initial encounter, 30(38%) were symptomatic with 26(87%) having symptoms referable to the side of the occluded internal carotid artery. During follow-up, 7(9%) had a neurologic event, of which 6(86%) were referable to the occluded side; 14(18%) patients underwent a contralateral operation. 19(24%) patients died during the period of study. Although numerous variables of multi-vessel disease were significant with Chi-square analysis, there was no significant risk factor associated with neurologic event upon multivariate analysis. The development of a hemodynamically significant stenosis (>50%) or occlusion of the external carotid artery (ECA) ipsilateral to the occlusion on follow-up (p<.027) was however, associated with increased risk of death. Kaplan-Meier analysis showed 7-year survival for patients with ECA disease at follow-up was significantly worse (16.2%±10.3% (n=21) vs. 79%±8.7% (n=59); p<.00001). Frequently, patients present with neurological symptoms referable to the side of internal carotid artery occlusion. Eighty-six percent of neurologic events that occur in follow-up are attributable to the side of the occluded carotid, indicating that the occluded side continues to contribute to neurologic morbidity over time. Multivariate analysis revealed no single factor to be predictive of subsequent neurologic events. With significant risk of death in patients found to have ipsilateral ECA stenosis during follow-up, it seems reasonable to continue surveillance of the occluded carotid.

The effects of consuming foods containing 0 (control), 3.4, 6.8, or 10.2 g psyllium seed husk (PSH)/d for 24 wk on the serum lipid profile were assessed in this randomized, double-blind controlled study. Men and women (n = 286) with LDL-cholesterol concentrations between 3.36 and 5.68 mmol/L (130 and 220 mg/dL) were randomly assigned to one of four treatment groups after following a low-fat diet for > or = 8 wk. At week 24, LDL cholesterol was 3% above baseline in the control group. In the group consuming 10.2 g PSH/d, LDL cholesterol remained below baseline during treatment, with a value 5.3% below that of the control group at week 24 (P < 0.05 compared with the control group). No significant differences were observed in HDL cholesterol or triacylglycerol. Although modest, the effect of 10.2 g PSH/d on LDL cholesterol (relative to the control) persisted throughout the 24-wk treatment period, indicating potential for long-term benefit.

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