Large and compound asymptomatic, nonstenotic carotid ulcers were associated with hemispheric stroke rates of 21% and 19% respectively over up to 10 years, compared to 3% for small ulcers.
Cohort (n=141)
What is the natural history and stroke risk of asymptomatic, nonstenotic ulcerative lesions of the carotid artery?
Large and compound asymptomatic, nonstenotic carotid ulcers carry a high annual stroke risk (4.5-7.5%), comparable to symptomatic patients, suggesting a potential benefit for prophylactic surgery.
Absolute Event Rate: 21% vs 3%
The natural history of 153 asymptomatic, nonstenotic ulcerative lesions of the carotid bifurcation in 141 patients was reviewed. A technique for quantitatively defining small (A), large (B), and compound (C) ulcers was developed. During the course of study, extending up to ten years, 3% of patients with A ulcers, 21% with B ulcers, and 19% with C ulcers had hemispheric strokes without antecedent transient ischemic attacks (TIAs), on the side appropriate to the lesion. The interval annual stroke rate was 4.5% for B ulcers and 7.5% for C ulcers. Because these interval stroke rates are comparable to the 6% annual stroke rate occurring in patients with TIAs, a well-accepted indication for operation, we recommend prophylactic operation for these lesions in good surgical candidates, to be performed by surgeons who have demonstrably low operative stroke rates.
Sherwood M. Dixon (1982) conducted a cohort in Asymptomatic, nonstenotic ulcerative lesions of the carotid artery (n=141). Large (B) and compound (C) carotid ulcers vs. Small (A) carotid ulcers was evaluated on Hemispheric strokes without antecedent transient ischemic attacks (TIAs) on the side appropriate to the lesion. Large and compound asymptomatic, nonstenotic carotid ulcers were associated with hemispheric stroke rates of 21% and 19% respectively over up to 10 years, compared to 3% for small ulcers.