Severity of asymptomatic carotid stenosis and risk of ipsilateral hemispheric ischaemic events: Results from the ACSRS study

A. N. Nicolaides, S. K. Kakkos, M. Griffin, M. Sabetai, S. Dhanjil, T. Tegos, D. J. Thomas, A. Giannoukas, G. Geroulakos, N. Georgiou, S. Francis, E. Ioannidou, C. J. Doré, R. Adovasio, B. Ziani, E. P. Aló, C. G. Cicilioni, G. Ambrosio, A. Andreev, G. M. AndreozziF. Verlato, G. Camporese, E. Arosio, E. Barkauskas, A. A.B. Barros D'Sa, P. Brannigan, V. Batchvarova, A. Dramov, P. Belardi, G. P. Novelli, G. Simoni, P. Bell, G. M. Biasi, P. Mingazzini, N. M. Bornstein, D. Bouchier-Hayes, P. Fitzgerald, M. A. Cairols, P. G. Cao, P. DeRango, G. P. Carboni, C. Geoffredo, M. Catalano, B. Chambers, M. Goetzmann, A. Dickinson, D. Clement, M. Bobelyn, S. Coccheri, E. Conti, E. Diamantopolous, E. A. Andreadis, L. Middleton, M. Pantziaris, T. Tyllis, E. Minar, A. Willfort, L. Moggi, G. Nenci, S. Radicchia, L. Norgren, E. Ribbie, S. Novo, R. Tantillo, D. Olinic, W. Paaske, A. Pagnan, P. Pauletto, V. Pagliara, G. Pettina, C. Pratesi, S. Matticari, J. Polivka, P. Sevcik, P. Poredos, A. Blinc, V. Videcnik, A. Pujia, A. Raso, P. Rispoli, M. Conforti, T. Robinson, M. S.J. Dennis, S. Rosfors, G. Rudofsky, T. Schroeder, M. L. Gronholdt, G. Simoni, C. Finocchi, G. Rodriguez, P. B. Dimakakos, T. Kotsis, B. Eikelboom, L. Entz, Ferrari-Bardille, T. Aloi, M. Salerno, J. Fernandes e Fernandes

Research output: Contribution to journalArticle

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Abstract

Objectives. This study determines the risk of ipsilateral ischaemic neurological events in relation to the degree of asymptomatic carotid stenosis and other risk factors. Methods. Patients (n = 1115) with asymptomatic internal carotid artery (ICA) stenosis greater than 50% in relation to the bulb diameter were followed up for a period of 6-84 (mean 37.1) months. Stenosis was graded using duplex, and clinical and biochemical risk factors were recorded. Results. The relationship between ICA stenosis and event rate is linear when stenosis is expressed by the ECST method, but S-shaped if expressed by the NASCET method. In addition to the ECST grade of stenosis (RR 1.6; 95% CI 1.21-2.15), history of contralateral TIAs (RR 3.0; 95% CI 1.90-4.73) and creatinine in excess of 85 μmol/L (RR 2.1; 95% CI 1.23-3.65) were independent risk predictors. The combination of these three risk factors can identify a high-risk group (7.3% annual event rate and 4.3% annual stroke rate) and a low risk group (2.3% annual event rate and 0.7% annual stroke rate). Conclusions. Linearity between ECST percent stenosis and risk makes this method for grading stenosis more amenable to risk prediction without any transformation not only in clinical practice but also when multivariable analysis is to be used. Identification of additional risk factors provides a new approach to risk stratification and should help refine the indications for carotid endarterectomy.

Original languageEnglish
Pages (from-to)275-284
Number of pages10
JournalEuropean Journal of Vascular and Endovascular Surgery
Volume30
Issue number3
DOIs
Publication statusPublished - Sep 1 2005

Keywords

  • Asymptomatic
  • Carotid
  • ECST
  • NASCET
  • Risk
  • Stenosis

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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    Nicolaides, A. N., Kakkos, S. K., Griffin, M., Sabetai, M., Dhanjil, S., Tegos, T., Thomas, D. J., Giannoukas, A., Geroulakos, G., Georgiou, N., Francis, S., Ioannidou, E., Doré, C. J., Adovasio, R., Ziani, B., Aló, E. P., Cicilioni, C. G., Ambrosio, G., Andreev, A., ... Fernandes e Fernandes, J. (2005). Severity of asymptomatic carotid stenosis and risk of ipsilateral hemispheric ischaemic events: Results from the ACSRS study. European Journal of Vascular and Endovascular Surgery, 30(3), 275-284. https://doi.org/10.1016/j.ejvs.2005.04.031