Optimal Medical Management Reduces Risk of Disease Progression and Ischemic Events in Asymptomatic Carotid Stenosis Patients: A Long-Term Follow-Up Study

Abstract

Background and Purpose: To assess the effect of optimal medical management including atherosclerotic risk factor control on ischemic stroke (IS), transient ischemic attack (TIA), carotid revascularization (CRV), and progression of severity of carotid stenosis (PSCS) in patients with asymptomatic carotid artery stenosis (ACAS). Methods: We conducted a retrospective analysis of patients with ACAS (who had at least 3 serial carotid duplex ultrasounds) for incidence of IS, TIA, and PSCS. Results: Eight hundred sixty-four patients with a mean follow-up duration of 79 ± 36 months were included. IS/TIA and CRV occurred in 12.2% of the patients and PCSS was observed in 21.5% vessels. On univariate analysis it was found that low-density lipoprotein (LDL) levels >100 mg/dL, no statin or low-potency statins, average systolic blood pressure (SBP) ≥140 mm Hg and/or diastolic blood pressure (DBP) ≥90 mm Hg and history of smoking were predictors of the combined endpoint of IS/TIA/CRV and PSCS. On multivariate analysis, it was found that LDL >100 mg/dL, no statin or low-potency statin, SBP ≥140 mm Hg and/or DBP ≥90 mm Hg, and Hx of smoking were independent predictors of PSCS. Similarly no statin or low-potency statin, SBP ≥140 mm Hg and/or DBP ≥90 mm Hg, Hx of atrial fibrillation/flutter, Hx of chronic kidney disease, and PSCS were independent predictors of IS/TIA. No statin or low-potency statin, SBP ≥140 mm Hg and/or DBP ≥90 mm Hg, diabetes mellitus, baseline carotid artery stenosis ≥70%, and PSCS were found to be independent predictors of combined endpoint IS/TIA and CRV. Conclusion: Intensive medical therapy in the patients with ACAS results in lower incidence of IS/TIA, CRV, and PSCS with a significant incremental beneficial effect.

Atherosclerotic Extension of Carotid Arteries: An Insertion in Clinical Practice

“…The results of the present study add up to 8.8% for lesions above 50% in patients with PAD, and 6.2% over 70%, which, to date, meet the few published findings, but with lower values when compared to published studies ranging from 5 to 24% in patients with PAD [11][12][13]. In the Present Review of Asymptomatic Carotid Stenosis (2020), the authors found 13.4% prevalence of moderate stenosis and 21.8% for severe stenosis [21].…”

“…We know that PAD is a systemic disease and that it represents a high-risk factor for cardiovascular events [8][9][10], and we have only a few studies addressing this association, with evidences for the prevalence of atherosclerotic disease, which is higher in patients with PAD than in patients without PAD [11][12][13].…”

Angioplasty in asymptomatic carotid artery stenosis vs. endarterectomy compared to best medical treatment: One-year interim results of SPACE-2

“…These factors have shown to reduce risk of ischemic events or progression of stenosis. 14,41 In specific cases, selected patients with high-risk stenosis (e.g. cerebral microembolization, intraplaque hemorrhage, echolucent plaque formation, silent embolic infarcts on brain imaging, or reduced cerebral blood flow reserve) should be considered for treatment with interventional methods.…”

The year 2018 in cardiology: aorta and peripheral circulation

“…1 This has recently been confirmed in 864 patients with 50-69% or 70-99% carotid artery stenosis. 21 Altogether, 4929 carotid ultrasound studies were performed on 1439 carotid arteries over 6.5 years. Ischaemic stroke/transient ischemic attack (TIA) and carotid revascularization occurred in 12.2% and progression of the stenosis in 21.5% of patients.…”

“…21 Altogether, 4929 carotid ultrasound studies were performed on 1439 carotid arteries over 6.5 years. Ischaemic stroke/transient ischemic attack (TIA) and carotid revascularization occurred in 12.2% and progression of the stenosis in 21.5% of patients. The quality of risk factors control were independent predictors for the stenosis progression or occurrence of stroke/TIA (Figure 1).…”