The natural history of asymptomatic carotid artery disease

Abstract

This study, while confirming significant risk for asymptomatic patients with critical stenosis or echolucent plaque, demonstrates the importance of contralateral disease and the absence of orderly progression from minimal disease through high-grade stenosis to symptomatic cerebral ischemia. TIA and stroke commonly occur in association with abrupt, unpredictable, quantum changes in carotid artery disease.

Carotid Artery Disease and the Risk of Ischaemic Stroke and Coronary Vascular Events

“…Symptomatic plaques are more frequently echolucent than asymptomatic plaques, and echolucent plaques are more frequently associated with surface ulceration than echogenic plaques [69, 70]. However, although there is evidence that echolucent plaques are associated with a higher incidence of cerebral infarction at baseline than echogenic plaques [71], they do not appear to be associated with a higher frequency of microemboli [72], and there is relatively little evidence that they identify individuals with an increased risk of future ischaemic stroke [47, 73]. More data are required before the echogenicity of carotid plaque can be used to identify individuals at increased risk of stroke.…”

Characteristics of carotid artery disease (CAD) and presenting cerebrovascular symptoms in an aged group

“…During last decades, studies had revealed that stenosis of the carotid arteries is associated with an increased risk for TIAs and stroke in asymptomatic patients [19]. For patients with high risks of CAD, measurement of luminal diameter narrowing as DSA or MRA, CTA might supply further information for the next CEA or surgery or conservative treatment earlier, and might control the progress of symptoms.…”

Asymptomatic Carotid Artery Stenosis: Past, Present and Future

“…Risk of any ipsilateral neurological deficit increases with the severity of the asymptomatic CAS. Published annual risk of ipsilateral neurological deficits for asymptomatic CAS <50%, between 50 and 80% and >80% are 0–3.8%, 2–5% and 1.7–18%, respectively (table 2) [3, 12, 18, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44]. The majority of these neurological deficits seems transient neurological attacks (TIAs) or amaurosis fugax, but risk of ipsilateral stroke or permanent neurological deficit must not be underestimated and can affect up to half of these patients.…”

“…The risk of progression of an asymptomatic CAS increases with time and varies from 4 to 29% per year, depending on the definitions of stenosis progression and studied population (table 4) [28, 35, 40, 51, 54, 55, 56, 57, 58, 59, 60]. Several studies have tried to describe the natural history of asymptomatic CAS, to define risk factors or predictors for stenosis progression by multiple linear regression analysis, and to find a relation between stenosis progression and neurological symptoms.…”