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Natural History of > 60% Asymptomatic Carotid Stenosis in Patients With Contralateral Carotid Occlusion

Division of Peripheral Vascular Surgery, Loyola University Medical Center, Maywood, Illinois

William H. Baker, MD

Division of Peripheral Vascular Surgery, Loyola University Medical Center, Maywood, Illinois; 2160 South First Avenue, EMS, Bldg. 110, #3213, Maywood, IL 60153

Carotid endarterectomy was reported to be beneficial for patients with asymptomatic carotid stenosis of 60% or greater at the conclusion of the Asymptomatic Carotid Atherosclerosis Study, but other studies report mixed results. In a prospective study of contralateral carotid occlusion, the authors analyzed the natural history of asymptomatic carotid stenosis in patients with of 60% or greater stenosis. Over a 1 0-year period, 82 patients were examined both clinically and with duplex surveillance every 6 months and received maximum medical therapy. If lesions progressed to 70% or greater or became symptomatic then carotid endarterectomy was considered. Mean follow-up was 59.5 months (7 to 141 months). A 60% rate of combined neurologic events of transient ischemic attack and stroke was noted: in 27 patients (33%) late strokes occurred; 8 were contralateral and 19 were ipsilateral, and 22 patients had late transient ischemic attacks (15 contralateral, 7 ipsilateral). Late carotid endarterectomy was performed in 21 patients. A Kaplan-Meier analysis showed that freedom from ipsilateral stroke at 5 years was 73%, but the study results showed the rate at 5 years to be 63%. The authors concluded that the incidence of ipsilateral strokes and all strokes in patients with asymptomatic carotid stenosis of between 60% and 70% and with contralateral carotid occlusion is higher than was has been reported in other studies and that they may benefit from prophylactic carotid endarterectomy.

Key Words: contralateral carotid occlusion • natural history • moderate carotid stenosis • asymptomatic carotid disease

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