Low Stroke Risk in Patients With Asymptomatic Severe Carotid Stenosis

 Well I had carotid stenosis that developed into complete right artery blockage, which was a good thing since then my risk of stroke from that stenosis has completely dropped. If your doctor wants to treat your stenosis, tell them you want a guarantee of NO problems from either stenting or carotid endarterectomy.

Possible problems:

Ticagrelor Induced Angioedema Following Carotid Artery Stenting

Cognitive Dysfunction and Mortality After Carotid Endarterectomy

 

For me, with no medical background the best solution is to determine if the Circle of Willis is complete, then close up the offending artery. Don't listen to me.

Low Stroke Risk in Patients With Asymptomatic Severe Carotid Stenosis

In a community-based cohort of patients with asymptomatic severe carotid stenosis who did not undergo surgical intervention, the estimated rate of ipsilateral carotid-related acute ischaemic stroke was 4.7% over 5 years.

The findings, published in JAMA, may inform decision-making regarding surgical and medical treatment for patients with asymptomatic severe carotid artery stenosis.

“The question of how to best treat patients with narrowing of the carotid artery without symptoms has been a long-standing research priority,” said Robert Chang, MD, Kaiser Permanente Division of Research, Oakland, California. “We decided to take a step back and to begin our study by asking how likely it is that these patients will actually have a stroke related to their severe stenosis. Our analyses showed that this risk is so low that it appears that, for most patients, surgery may not be necessary.”

The study included 3,737 adult participants with asymptomatic severe (70%-99%) carotid stenosis diagnosed between 2008 and 2012 and no prior intervention or ipsilateral neurologic event in the prior 6 months. Participants received follow-up through 2019. Of the patients, 1,423 had surgery to treat the stenosis and 2,314 did not.

Prior to any intervention, there were 133 ipsilateral strokes with a mean annual stroke rate of 0.9%. The Kaplan-Meier estimate of ipsilateral stroke by 5 years was 4.7% (95% confidence interval, 3.9%-5.7%).

“We suspected that we may find a low risk of stroke in these patients because there are now better stroke-prevention treatments, including medications to control blood pressure, prevent blood clots, and reduce cholesterol, than when the original randomised trials were done,” said Mai N. Nguyen-Huynh, MD, Kaiser Permanente. “I think our study will make many patients and their doctors think twice about surgery if they can instead be on an effective aggressive medical management program to lower their stroke risk from asymptomatic carotid disease.”

The researchers are affiliated with a national randomised clinical trial, called CREST2, that is enrolling patients in a study comparing surgery or stenting to medical management in patients with asymptomatic severe carotid stenosis.

“This head-to-head comparison of carotid surgery versus medical management in a clinical trial is what we need to help us determine the appropriate approach,” said Dr. Nguyen-Huynh.

Reference: https://jamanetwork.com/journals/jama/article-abstract/2792617

SOURCE: Kaiser Permanente