Asymptomatic carotid artery disease

Asymptomatic carotid artery disease, which includes nonstenosing plaque or carotid stenosis, is frequent and increases with age, occurring in 53.6% of subjects 65 to 94 years of age. Among individuals with asymptomatic carotid disease, the annual stroke risk was 1.3% in those with stenosis of 75% or less and 3.3% in those with stenosis of more than 75%, with an ipsilateral stroke risk of 2.5%. The combined TIA and stroke risk was 10.5% per year in those with more than 75% carotid stenosis. The occurrence of symptoms may be dependent on the severity and progression of the stenosis, the adequacy of collateral circulation, the character of the atherosclerotic plaque, and the propensity to form thrombus at the site of the stenosis. Read more facts on this website.

Transient ischemic attacks are a strong predictor of subsequent stroke with annual stroke risks of 1% to 15%. The first year after a TIA is associated with the greatest stroke risk. In hospital-referred patients, the average annual risk of stroke, myocardial infarction or death was 7.5% after TIA. Amaurosis fugax or transient monocular blindness (TMB) had a better outcome than cerebral ischemic attacks and stroke usually occurred in the same vascular territory as-the initial TIA.

Risk Factor Modification

Risk factor modification may be attempted either through the “high risk approach” which identifies and seeks to modify the degree of risk in individuals with increased risk of disease; or through a “mass” approach which targets modification of risk factors detectable through the screening of large populations. Gorelick has estimated the potential savings, in lives and dollars, associated with either a “mass” or “high risk” prevention program. Based on the estimated prevalence of risk factors and their attributable risks for stroke in the United States, it is estimated that 246,500 strokes could be prevented from the control of hypertension alone and associated with a savings of $12.33 billion. A prevention program aimed at cigarette smoking could prevent over 61,000 strokes with an associated savings of over $3 billion. Even if these programs were only 25% successful in reducing hypertension and smoking, over $3.8 billion may be saved in stroke related care. Treatment of atrial fibrillation and modification of heavy alcohol use could eliminate 47,000 and 23,500 strokes, respectively.

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