Differential Incidence of Ipsilateral Ischemic Stroke in patients with Asymptomatic Carotid Stenosis

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Objective To investigate incidences of ipsilateral ischemic stroke (IS) and other outcomes for medically and surgically treated asymptomatic carotid stenosis (ACS). Design Observational, nationwide cohort study. Methods The Swedish vascular registry (Swedvasc) was used to identify patients undergoing carotid intervention, who had a contralateral non-operated ACS (medically treated ACS) as well as patients with surgically treated ACS 2008-2017. Swedvasc was merged with the National stroke register to determine stroke incidence. Hospital records were obtained to determine stroke type and laterality. Primary outcome was ipsilateral ischemic stroke (IS) beyond the perioperative 30-days period. Secondary outcomes included any stroke and all-cause mortality. For surgically treated ACS, perioperative stroke or death and the composite outcome perioperative stroke or death plus late ipsilateral IS were analyzed. Cox regression was used to analyze the influence of clinical risk factors and assess risk differences between groups. Results There were 1 457 patients with medically treated ACS and 1023 patients with surgically treated ACS. Patients with medically treated ACS were almost 5 years older than those with surgically treated ACS. Mean yearly incidences of outcomes for medically and surgically treated ACS were 1.1% and 0.3% for ipsilateral IS, 2.4% and 1.2% for any stroke and 5.6% and 3% for all-cause mortality. Clinical risk factors were not significantly associated with ipsilateral IS in either group, including severity of baseline stenosis (50-69% vs 70-99%). Comparing ipsilateral IS for medically treated ACS with perioperative stroke or death (2.6%) plus late ipsilateral IS for surgically treated ACS resulted in a projected minimum number needed to treat by surgery of 71 to avoid one ipsilateral IS over 5 years. Conclusion Incidences of ipsilateral IS were low for medically treated ACS and very low for surgically treated ACS. The present results suggest that best medical treatment is preferable for the majority of patients with ACS.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.