OUTCOME OF ASYMPTOMATIC PATIENTS WITH CAROTID DISEASE

Asymptomatic cervical atherosclerosis carries a variable risk of vascu lar events. We sought to identify patients with asymptomatic cervical bruits who may be at increased risk of developing ischemic events. We conducted a prospective multicenter cohort study of neurologically asy mptomatic patients presenting a cervical bruit. Patients had biannual neurologic and carotid duplex evaluation. Association between ultrason ographic findings and vascular events, adjusting for common risk facto rs, was evaluated. Seven hundred fifteen patients were followed on ave rage for 3.6 years. Mean age was 65 years, At initial visit, 357 subje cts had a greater than or equal to 50% stenosis. Overall, 237 events o ccurred in 177 patients. Annual rate of all primary vascular events in patients with greater than or equal to 50% stenosis was 11.0% versus 4.2% in those with <50% stenosis (p < 0.001). Annual rate of stroke an d vascular death was 5.5% in the greater than or equal to 50% group co mpared with 1.9% in the <50% group (p < 0.001), Yearly rate of unheral ded ischemic stroke was 4.2% in subjects with greater than or equal to 80% stenosis and 1.4% in those with stenosis <80% (p = 0.001). A stro ke or TIA was ipsilateral to a greater than or equal to 80% stenosis i n 66% of patients. Progression of carotid stenosis particularly to mor e than 80% was associated both with a higher rate of ipsilateral neuro logic events and overall combined vascular events. Our data suggest th at severity of carotid stenosis is the main risk factor predicting occ urrence of neurologic and other vascular events. Yearly rate of ipsila teral stroke with greater than or equal to 50% carotid stenosis is low (1.4%) and most are nondisabling. Progression to greater than or equa l to 80% or occlusion is associated with worse outcome.