Abstract
ObjectiveTo assess the risk of recurrent ipsilateral ischemic stroke in patients with symptomatic near-occlusion with and without full collapse.MethodsIncluded were consecutive patients eligible for revascularization, grouped into symptomatic conventional ≥ 50% carotid stenosis (n = 266), near-occlusion without full collapse (n = 57) and near-occlusion with full collapse (n = 42). The risk of preoperative recurrent ipsilateral ischemic stroke was analyzed, or, for cases not revascularized within 90 days, 90-day risk was analyzed.ResultsThe risk of a preoperative recurrent ipsilateral ischemic stroke or ipsilateral retinal artery occlusion was 15% (95% CI 9–20%) for conventional ≥ 50% stenosis, 22% (95% CI 6–38%) among near-occlusion without full collapse and 30% (95% CI 16–44%) among near-occlusion with full collapse (p = 0.01, log rank test). In multivariate analysis, near-occlusion with full collapse had a higher risk of recurrent ipsilateral ischemic stroke (adjusted HR 2.6, 95% CI 1.3–5.3) and near-occlusion without full collapse tended to have a higher risk (adjusted HR 2.0, 95% CI 0.9–4.5) than conventional ≥ 50% stenosis. Only 24% of near-occlusion with full collapse underwent revascularization, common causes for abstaining were misdiagnosis as occlusion (31%), deemed surgically unfeasible (21%) and low perceived benefit (10%).ConclusionsSymptomatic carotid near-occlusion has a high short-term risk of recurrent ipsilateral ischemic stroke, especially near-occlusion with full collapse.
Highlights
Carotid near-occlusion is a severe carotid stenosis that causes a reduction of the size of the internal carotid artery (ICA) distal to the stenosis [1,2,3]
The main finding of this study was that the risk of recurrent ipsilateral ischemic stroke was high among all patients with symptomatic near-occlusion, especially near-occlusion with full collapse
Our choice of endpoint was similar to NASCET and ECST, as we used the time based definition of stroke, not the novel ICD 11 stroke definition, and that we included retinal artery occlusions in our primary endpoint [13]
Summary
Carotid near-occlusion is a severe carotid stenosis that causes a reduction of the size of the internal carotid artery (ICA) distal to the stenosis [1,2,3]. In the pooled analysis of NASCET and ECST, 246 of 262 cases with near-occlusions were without full collapse and only 16 had criteria for near occlusions with full collapse [3]. These trials strongly suggested that carotid endarterectomy (CEA) is of less value for patients with near occlusion than for patients with severe stenosis but without near occlusion [3]. Since more than half of nearocclusions in NASCET and ECST were included > 4 weeks
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
