Asymptomatic carotid stenosis in patients on medical treatment alone.

Conference item

OBJECTIVE: the aim of this study was to investigate the effect of currently recommended medical treatment (MT) on changes in carotid stenosis in a group of asymptomatic patients taken from the Asymptomatic Carotid Surgery Trial (ACST). METHOD: collaborators in ACST were given information on MT for stroke prevention (including antiplatelet agents, lipid-lowering drugs, diabetic and hypertension control). Patients underwent clinical examination and duplex scanning at entry, 4 months following randomisation and annually thereafter. The cohort of patients studied were those randomised to MT with complete follow up duplex datasets at four years (n=219). None had undergone carotid endarterectomy (CEA) or developed ipsilateral carotid symptoms. RESULTS: there was no change in median carotid stenosis over four years (baseline 79% (IQR 10%) and 4 year median 79% (IQR 10%)) a median difference of 0 with Q1=-5 and Q3=+5 (p=0.98 Wilcoxon one sample test), whilst in many patients' stenoses progressed and regressed during this time. No individual MT variable correlated with stenosis progression or regression. CONCLUSION: in this group of ACST patients on MT, mean carotid stenosis was unchanged over 4 years. Individual patients' stenoses progressed (and regressed) without symptoms occurring. An increase in stenosis should not be the sole basis for deciding to operate on an asymptomatic patient.

Authors: Sleight, S; Poloniecki, J; Halliday, A

• Publication status: Published
• Host title: European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
• Volume: 23
• Issue: 6
• Pages: 519-523
• Publication date: 2002-06-01
• Event location: England
• DOI: 10.1053/ejvs.2002.1649
• EISSN: 1532-2165
• ISSN: 1078-5884
• Keywords: Cohort Studies; Treatment Outcome; Aged; Disease Progression; Asymptomatic Carotid Surgery Trial corraborators; Carotid Stenosis; Female; Male; Retrospective Studies; Stroke; Risk Factors; Ultrasonography, Doppler, Duplex; Humans; Remission, Spontaneous; Follow-Up Studies