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Medical therapy alone may not prevent carotid-related stroke
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Carotid-mediated stroke frequently occurred in previously asymptomatic patients with carotid stenosis, even if they were on appropriate medical therapy, researchers reported.
However, in that population, being on appropriate medical therapy reduced risk for severe, debilitating stroke.
“These data suggest that medical therapy alone is unlikely to completely extinguish stroke risk in patients with significant carotid bifurcation atherosclerotic stenosis,” W. Darrin Clouse, MD, FACS, RPVI, medical director of the Noninvasive Vascular Laboratory at Massachusetts General Hospital, said in a press release. “The proper identification of stenosis, medical therapy institution, proper surveillance for progression and revascularization are all important in minimizing progression to carotid-related stroke.”
The researchers analyzed 219 patients (mean age, 68 years; 66% men) admitted to Mass General between 2005 and 2015 for ischemic stroke whose etiology was adjudicated as carotid-related.
In the cohort, predominant risk factors were hypertension (79%) and smoking (33% current; 29% former).
According to the researchers, upon admission, 50% of patients were using antiplatelet therapy (41% aspirin, 4% clopidogrel, 5% dual antiplatelet therapy) and 55% were using lipid-lowering agents (53% statins, 2% other).
However, only 35% of patients were using both antiplatelet agents and lipid-lowering agents, Clouse and colleagues found.
Moderate or severe stroke, defined as an NIH Stroke Scale score of at least 5, was observed in 71% of patients upon admission, and 25% of the cohort received lytic therapy upon arrival.
Forty-three percent had an occluded ipsilateral carotid artery and 53% had carotid revascularization — either carotid stenting or endarterectomy — at a median of 4 days, Clouse and colleagues wrote.
“Nearly one-half of the patients we identified presented with complete internal carotid occlusion at time of their first symptoms, largely making them ineligible for stroke-risk reduction with [carotid endarterectomy] or stenting,” Clouse said in the release. “The effect of this inability to salvage carotid perfusion in patients with occlusion should be included in the assessment of risks and benefits associated with asymptomatic carotid revascularization.”
Compared with the rest of the cohort, patients receiving both antiplatelet agents and lipid-lowering agents were less likely to have a moderate or severe stroke (44% vs. 78%; P = .006), according to the researchers. – by Erik Swain
Disclosures: The authors report no relevant financial disclosures.
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