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HIGHER-GRADE CONTRALATERAL STENOSIS IS ASSOCIATED WITH INCREASED RISK OF STROKE IN PATIENTS WITH ASYMPTOMATIC CAROTID STENOSIS
Abstract
Background and Aims
Patients with asymptomatic carotid artery stenosis (ACS) are at low risk of stroke. Carotid thrombendarterectomy (TEA) and carotid artery stenting (CAS) can be used as interventional treatment procedures. Therefore, it is relevant to identify those in this population who show an increased risk of intervention or risk of stroke in the natural history. Higher-graded contralateral stenoses are known to be a risk factor in patients with ACS.
Methods
The randomized, controlled, multicenter SPACE-2 trial included patients with ACS in three treatment arms: TEA+best medical treatment (BMT) vs. CAS+BMT vs. BMT only. Due to insufficient randomization, the trial had to be stopped prematurely after enrolling 513 patients. Within the first year, patients with higher-grade contralateral stenoses (70-100% ECST) were assessed for increased risk of stroke.
Results
74 (14%) of 513 patients had a higher-grade contralateral carotid stenosis of 70-100% ECST and there was a trend for more major secondary endpoint events (6% vs. 2%; p=0.073). Subgroup analysis of the individual study arms showed a significant increase in risk in the TEA group for stroke within the first month after intervention (13% vs, 1%; p=0.013) and a for major secondary endpoint events (13% vs. 1%; p=0.013). Patients with contralateral carotid occlusion (CCO) showed a trend for more major secondary endpoint events (11% vs. 2%; p=0.062) and significantly higher rates of any stroke (17% vs. 3%; p=0.018).
Conclusions
In patients with ACS, higher-grade contralateral stenoses were associated with a higher risk of cerebrovascular events. Because of the small sample size, the results must be interpreted cautiously.