Skip to main content
2023 Vascular Annual Meeting Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
Live Stream
Live Stream
Registration Required
Registration Required
Contains DEI content
Contains DEI content
Back

SVS-VESS Scientific Session @ VAM: Session 1

VESS07 - Mid-term Results of the Carotid Asymptomatic Stenosis Observational Study

Wednesday, June 14, 2023
2:18 PM – 2:25 PM ET
Objectives: The present study analyzes the mid term results from an ongoing prospective observational study of patients with CARAS to assess their risk of CIE in a real world scenario.

Methods: This is a prospective observational cohort study of patients with CARAS >60% (NASCET-criteria) identified in a single duplex ultrasonography (DUS) vascular laboratory (trial registered: NCT04825080). Patients were not considered for CEA due to their high surgical risk or advanced age (>80 year) or absence of signs of plaque vulnerability (ulceration, non-echogenicity). Patient’s enrollment started in January 2019 and ended in March 2020. The aimed sample size calculated was 300 patients for a 5-year period of follow-up. Clinical characteristics, risk factors and medical therapies were collected and best medical therapy (BMT: antiplatelet, pressure control and statins) was recommended if necessary at the first clinical visit. The primary endpoint was to evaluate CIEs (strokes, transient ischemic attacks, amaurosis-fugax) ipsilateral to CARAS and assess plaque progression rate and patients survival. The follow-up is performed through a clinical visit and carotid DUS examination every year with telephone interviews at six-month intervals.

Results: A total of 377 patients were enrolled in the study and 306(81%) completed the follow-up. The mean age was 80±7 years, 55% were male. Contralateral stenosis >60% was present in 61 (20%) patients. Seventy-seven percent of patients were on BMT. At a mean follow-up of 40±10 months, 7 (2.3%) ispilateral strokes and 11 (3.6%) TIA occurred for a total of 16 CIE (5.2%; 2 patients experienced both TIA and stroke). At 4-year follow-up the freedom from ipsilateral ischemic events was 94±2%, with 1.5% annual CIEs. Plaques progression was associated with a significant lower freedom from CIE: 91±4.3% vs 95±1.7%, P=.05.

Conclusions: The mid-term results of this prospective study suggest that the rate of CIE is higher than expected in patients under BMT and that plaque progression is the main predictor of new cerebral events. These data should be considered in the current CEA efficacy debate.