Abstract Number: Esoc2026a1789 Real-World Risk of Stroke and Death in Asymptomatic Carotid Artery Stenosis: A Retrospective Population-Based Cohort Study

Abstract Background and aims Real-world risks of stroke and death in patients with asymptomatic carotid artery stenosis (ACAS) treated with optimal medical therapy (OMT) remain unclear. In the Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST-2), carotid artery stenting added to OMT reduced the composite endpoint of early stroke or death and 4-year ipsilateral ischemic stroke compared with OMT alone (2.8% vs 6.0%). Aim of this study was to assess real-world risks of stroke and death, and medication adherence, in patients with ACAS treated with OMT compared with background population controls. Methods Retrospective, population-based cohort study of patients with ≥50% ACAS identified in the Northern Denmark Region, 2013–2017. Five-year risks of death, any stroke, ischemic stroke, ipsilateral stroke, and medication adherence were compared with age-, sex-, and comorbidity-matched control group (1:4 ratio). Cumulative risks and adjusted risk ratios were estimated. In patients with ≥70% ACAS, the CREST-2 composite endpoint was evaluated. Results Among 9,708 carotid ultrasounds, 320 patients with ACAS were identified. Compared with matched controls, 5-year risks were 47% for death or stroke (RR 1.45), 20% for any stroke (RR 4.03), 15% for ischemic stroke (RR 4.76), and 8% for ipsilateral stroke. The CREST-2 endpoint occurred in 12%. Medical adherence was decreased to 50% for antiplatelets and 46% for statins in the 5th year. Conclusions Real-world patients with ACAS experienced higher rates of stroke and death, compared to the matched background population, and compared to the risk reported in the CREST-2 clinical trial setting. Conflict of interest Nothing to disclose.