Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification

Abstract

The purpose of this study was to determine the cerebrovascular risk stratification potential of baseline degree of stenosis, clinical features, and ultrasonic plaque characteristics in patients with asymptomatic internal carotid artery (ICA) stenosis

Stratifying risk: asymptomatic carotid disease

“…In this trial, patients with contralateral ischemic brain events secondary to carotid plaque were found to have more ipsilateral strokes than those with ipsilateral carotid stenosis and no significant or asymptomatic contralateral diseases (35 vs. 11, p=0.0004) 5 . The results of the ACST are in agreement with those found in the ACSRS trial conducted by Nicolaides et al 10 . In the latter, 1,121 patients with asymptomatic carotid plaque who had a history of contralateral TIAs or stroke had an increased risk of ipsilateral cerebrovascular or retinal ischemic event (hazard ratio -HR=2.35; 95%CI 1.60-3.43) and ipsilateral stroke (HR=3.03; 95%CI 1.77-5.20) 10 .…”

“…The degree importance of the carotid stenosis and its correlation to cerebrovascular events have been demonstrated by several studies 4,10,18,28 . Treatment is often indicated for ACAD when a >60% stenosis is detected 4,5,28 .…”

“…Whilst the outcomes in the symptomatic group are poor if not treated in a timely fashion, the course of ACAD has a low event rate and therefore a much better prognosis. The natural history of ACAD has been extensively studied over the past three decades 10,[12][13][14][15][16][17][18][19][20] . ACAD patients are identified from the presence of cervical bruits, during the investigation of nonspecific signs and symptoms and prior to pre-operative evaluation for cardiac or other major surgery.…”

“…Recent research on the plaque morphology and its components graded using grayscale median (GSM), white areas, and the area of the plaque have assisted in gauging the "benign" versus unstable plaques from cerebral and retinal ischemic embolic events 10,27 . The largest prospective study on patients with ACAD enrolled 1,121 consecutive patients as part of the Asymptomatic Carotid Stenosis and Risk of Stroke (ACSRS) Study Group 10 . All patients had DU assessment of the internal carotid artery (ICA) stenosis and plaque morphology, which were correlated to clinical characteristics and followed-up for a mean period of four years.…”

“…The role of plaque morphology and its instability causing either embolization or in situ thrombosis has been discussed 10,11 . Clinical features including cardiovascular risk factors (i.e., hypertension, hyperlipidemia) and life-style habits (i.e., smoking), coupled with plaque morphology and degree of stenosis, are important factors attributed to increased risk of disease progression and adverse outcomes, such as TIA and stroke.…”