Stroke risk may not be great enough of an excuse to perform carotid stenting during carotid occlusion thanks to the procedure’s high-risk reputation, new research indicates.
J. David Spence, MD, of Western University in Ontario, Canada, and colleagues analyzed the risk resulting from progression to carotid occlusion in patients with asymptomatic carotid stenosis. Previously, prevention of carotid occlusion was seen as a valid indication for stenting, however risk of stroke from occlusion may be far lower than the risk that the stenting procedure holds.
Data from 3,681 patients (mean age= 66 years) was collected from the Stroke Prevention Clinic of Victoria Hospital from January 1, 1990 through December, 31, 1995 and from the Stroke Prevention at University Hospital from January 1, 1995 through December 31, 2012. Of the patients, 316 (8.6%) were asymptomatic before an index occlusion that occurred during observation. The researchers noted that over 80% of occlusions occurred before 2002, when medical therapy was less intensive.
Only one patient had a stroke at the time of occlusion and three patients had an ipsilateral stroke during follow-up. Neither stenosis severity or contralateral occlusion predicted the risk of ipsilateral stroke or transient ischemic attack, death from stroke, or death from an unknown cause.
“Patients with carotid stenosis are at high risk of death, but … most of the deaths are not from stroke. Carotid stenting or endarterectomy can therefore not be expected to improve those outcomes,” the authors wrote. “The risk of ipsilateral stroke at the time of carotid occlusion was well below the risk of carotid stenting or carotid endarterectomy, and the percent stenosis or contralateral occlusion did not identify patients who would benefit from intervention. Preventing carotid occlusion may not be a valid indication for intervention.”