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New evidence suggesting that carotid occlusion is not actually associated with a high risk for stroke — with the inference that many carotid stenting or endarterectomy procedures for asymptomatic patients therefore may do more harm than good — has come from a new study. The findings were published online in JAMA Neurology .

For the study, researchers retroactively examined carotid duplex scans and clinical outcome data from 3681 patients with asymptomatic carotid stenosis seen in an atherosclerosis clinic during a 20-year period. They found that the risk for progression to internal carotid artery occlusion fell over time, in line with the increasing use of more intensive medical therapy. The frequency of occlusion dropped dramatically in 2002/3, when intense medical therapy started to be used. In this study, 80% of the occlusions occurred before this time point,

The study also showed that of the 316 patients who progressed to carotid occlusion, only 1 patient (0.3%) had a stroke at the time of the occlusion, and only 3 patients (0.9%) had a stroke during an average 2.5-year follow-up

The researchers point out that this risk for stroke is far lower than that associated with carotid stenting or endarterectomy. They cite data from the CREST trial, which showed a 30-day risk for stroke or death among asymptomatic patients of 2.5% for stenting and 1.4% for endarterectomy and a 4-year risk of 4.5% and 2.7%, respectively. They note that real-world data show even higher risks, with a study in Medicare patients having reported a 1-year rate of stroke or death of 16.7% for stenting and 11.0% for endarterectomy

http://www.medscape.com/viewarticle/851367