Risk of stroke from new carotid artery occlusion in the Asymptomatic Carotid Surgery Trial-1.

Abstract:

BACKGROUND AND PURPOSE:In the Asymptomatic Carotid Surgery Trial-1 (ACST-1), 3120 patients with tight asymptomatic carotid stenosis were randomly assigned to medical treatment alone or to carotid endarterectomy and appropriate medication. Successful carotid endarterectomy significantly reduced 10-year stroke risk in younger patients. This study was undertaken to determine the risk of new occlusion and stroke during trial follow-up. METHODS:Patients with contralateral occlusion at trial entry (n=276) or incomplete duplex follow-up (n=137) were excluded. Risk of occlusion and stroke in patients with occlusion was estimated by Kaplan-Meier analysis. Cox proportional hazard regression models were used to determine risk factors for developing new occlusion and stroke. RESULTS:Median follow-up in 2707 patients was 80.0 months (interquartile range, 52.0-115.0). New occlusions occurred in 197 patients (1.1% per annum) but were more likely to occur in arteries with tight stenosis and in unoperated patients. Overall risk of stroke was 7.6% (95% confidence interval [CI], 6.6-8.7) and 15.5% (95% CI, 13.6-17.4) at 5 and 10 years, respectively; for patients with new occlusion, this significantly increased to 17.0% (95% CI, 11.6-22.4) and 20.8% (95% CI, 14.1-26.2), respectively (P<0.001). Stroke was significantly more likely to occur in patients developing occlusion (hazard ratio, 1.78; 95% CI, 1.26-2.51) irrespective of allocated treatment. CONCLUSIONS:New occlusions were uncommon after carotid endarterectomy in ACST-1. During long-term follow-up, occlusion and stroke were commoner among patients with ≥ 70% stenosis, most of whom had not undergone carotid endarterectomy. Occlusion was an independent prognostic risk factor for occurrence of stroke.

journal_name

Stroke

journal_title

Stroke

authors

den Hartog AG,Halliday AW,Hayter E,Pan H,Kong X,Moll FL,de Borst GJ,Asymptomatic Carotid Surgery Trial Collaborators.

doi

10.1161/STROKEAHA.111.000348

subject

Has Abstract

pub_date

2013-06-01 00:00:00

pages

1652-9

issue

6

eissn

0039-2499

issn

1524-4628

pii

STROKEAHA.111.000348

journal_volume

44

pub_type

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