S F Cheng1, M M Brown2, R J Simister3, T Richards1. 1. Division of Surgery and Interventional Science, University College London, London, UK. 2. Stroke Research Centre, Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK. 3. University College London Hospitals NHS Foundation Trust, London, UK.
Abstract
BACKGROUND: Carotid stenosis is a common cause of ischaemic stroke and transient ischaemic attack (TIA). Despite rising recognition and centralization of stroke services there has been a decline in interventions for carotid stenosis in recent years. The aim of this study was to determine the current prevalence and management of carotid stenosis in the UK. METHODS: This was a 1-year prospective observational study of consecutive patients presenting with ischaemic stroke, TIA or ischaemic retinal artery occlusion to a central London hyperacute stroke unit. Patients with significant carotid stenosis, defined as atherosclerotic narrowing of 50 per cent or greater, underwent multidisciplinary team (MDT) discussion to determine the cause of stroke/TIA and classify carotid stenosis as symptomatic or incidental. RESULTS: In total, 2707 patients were seen; half had an ischaemic event and the majority had carotid imaging (1252 of 1444). Carotid stenosis of at least 50 per cent was seen in 238 (prevalence 19·0 (95 per cent c.i. 16·6 to 21·4) per cent). Patients with significant carotid stenosis were more likely to have hypertension, hypercholesterolaemia, diabetes and ischaemic heart disease. Carotid stenosis was deemed symptomatic in 99 patients (7·9 (6·3 to 9·5) per cent); of these, 17 had carotid occlusion, 17 were unfit for surgery and 58 patients were referred for carotid intervention. Among 139 patients with asymptomatic stenosis, 75 had carotid stenosis ipsilateral to the stroke but, after MDT discussion, the cause was deemed to be atrial fibrillation (32), small-vessel disease (15), another determined cause (5), or not determined owing to atypical imaging or clinical presentation. CONCLUSION: Carotid stenosis is common, affecting one in five patients presenting with stroke or TIA. Careful MDT discussion may avoid unnecessary intervention and should be the standard of care.
BACKGROUND:Carotid stenosis is a common cause of ischaemic stroke and transient ischaemic attack (TIA). Despite rising recognition and centralization of stroke services there has been a decline in interventions for carotid stenosis in recent years. The aim of this study was to determine the current prevalence and management of carotid stenosis in the UK. METHODS: This was a 1-year prospective observational study of consecutive patients presenting with ischaemic stroke, TIA or ischaemic retinal artery occlusion to a central London hyperacute stroke unit. Patients with significant carotid stenosis, defined as atherosclerotic narrowing of 50 per cent or greater, underwent multidisciplinary team (MDT) discussion to determine the cause of stroke/TIA and classify carotid stenosis as symptomatic or incidental. RESULTS: In total, 2707 patients were seen; half had an ischaemic event and the majority had carotid imaging (1252 of 1444). Carotid stenosis of at least 50 per cent was seen in 238 (prevalence 19·0 (95 per cent c.i. 16·6 to 21·4) per cent). Patients with significant carotid stenosis were more likely to have hypertension, hypercholesterolaemia, diabetes and ischaemic heart disease. Carotid stenosis was deemed symptomatic in 99 patients (7·9 (6·3 to 9·5) per cent); of these, 17 had carotid occlusion, 17 were unfit for surgery and 58 patients were referred for carotid intervention. Among 139 patients with asymptomatic stenosis, 75 had carotid stenosis ipsilateral to the stroke but, after MDT discussion, the cause was deemed to be atrial fibrillation (32), small-vessel disease (15), another determined cause (5), or not determined owing to atypical imaging or clinical presentation. CONCLUSION:Carotid stenosis is common, affecting one in five patients presenting with stroke or TIA. Careful MDT discussion may avoid unnecessary intervention and should be the standard of care.
Authors: Michiel H F Poorthuis; Paul Sherliker; Dylan R Morris; M Sofia Massa; Robert Clarke; Natalie Staplin; Sarah Lewington; Gert J de Borst; Richard Bulbulia; Alison Halliday Journal: Eur J Vasc Endovasc Surg Date: 2021-01-07 Impact factor: 7.069
Authors: K C D Mettananda; U K Ranawaka; M D P Eshani; L M Wettasinghe; S Somaratne; Y P Nanayakkkara; W Sathkorala; A Upasena; C Sirigampola; P M Y Tilakaratna; A Pathmeswaran Journal: BMC Neurol Date: 2021-10-04 Impact factor: 2.474
Authors: Paul J Nederkoorn; Martin M Brown; Leo H Bonati; Suk Fun Cheng; Twan J van Velzen; John Gregson; Toby Richards; Hans Rolf Jäger; Robert Simister; M Eline Kooi; Gert J de Borst; Francesca B Pizzini Journal: Trials Date: 2022-07-27 Impact factor: 2.728
Authors: L Saba; W Brinjikji; J D Spence; M Wintermark; M Castillo; G J de Borst; Q Yang; C Yuan; A Buckler; M Edjlali; T Saam; D Saloner; B K Lal; D Capodanno; J Sun; N Balu; R Naylor; A V D Lugt; B A Wasserman; M E Kooi; J Wardlaw; J Gillard; G Lanzino; U Hedin; D Mikulis; A Gupta; J K DeMarco; C Hess; J V Goethem; T Hatsukami; P Rothwell; M M Brown; A R Moody Journal: AJNR Am J Neuroradiol Date: 2021-07-29 Impact factor: 4.966