Document Detail

Effects of intensive medical therapy on microemboli and cardiovascular risk in asymptomatic carotid stenosis.
MedLine Citation:
PMID:  20008646     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To assess the effect of more intensive medical therapy on the rate of transcranial Doppler (TCD) microemboli and cardiovascular events in patients with asymptomatic carotid stenosis (ACS). DESIGN: A prospective study. SETTING: A teaching hospital. PATIENTS: Four hundred sixty-eight patients with ACS greater than 60% by Doppler peak velocity. MAIN OUTCOME MEASURES: We compared (1) the proportion of ACS patients who had microemboli on TCD, (2) cardiovascular events, (3) rate of carotid plaque progression, and (4) baseline medical therapy, before and since 2003. RESULTS: Among 468 ACS patients, 199 were enrolled between January 1, 2000, and December 31, 2002; and 269 were enrolled between January 1, 2003, and July 30, 2007. Microemboli were present in 12.6% before 2003 and 3.7% since 2003 (P < .001). The decline in microemboli coincided with better control of plasma lipids and slower progression of carotid total plaque area. Since 2003, there have been significantly fewer cardiovascular events among patients with ACS: 17.6% had stroke, death, myocardial infarction, or carotid endarterectomy for symptoms before 2003, vs 5.6% since 2003 (P < .001). The rate of carotid plaque progression in the first year of follow-up has declined from 69 mm(2) (SD, 96 mm(2)) to 23 mm(2) (SD, 86 mm(2)) (P < .001). CONCLUSIONS: Cardiovascular events and microemboli on TCD have markedly declined with more intensive medical therapy. Less than 5% of patients with ACS now stand to benefit from revascularization; patients with ACS should receive intensive medical therapy and should only be considered for revascularization if they have microemboli on TCD.
J David Spence; Victoria Coates; Hector Li; Arturo Tamayo; Claudio Mu?oz; Daniel G Hackam; Maria DiCicco; Janine DesRoches; Chrysi Bogiatzi; Jonathan Klein; Joaquim Madrenas; Robert A Hegele
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-12-14
Journal Detail:
Title:  Archives of neurology     Volume:  67     ISSN:  1538-3687     ISO Abbreviation:  Arch. Neurol.     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-09     Completed Date:  2010-03-05     Revised Date:  2010-06-21    
Medline Journal Info:
Nlm Unique ID:  0372436     Medline TA:  Arch Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  180-6     Citation Subset:  AIM; IM    
Stroke Prevention and Atherosclerosis Research Centre, 1400 Western Road, London, Ontario, Canada.
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MeSH Terms
Carotid Stenosis / etiology*,  mortality
Chi-Square Distribution
Confidence Intervals
Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
Intensive Care / methods*
Intracranial Embolism / complications*,  therapy*
Kaplan-Meiers Estimate
Lipids / blood
Middle Aged
Plaque Assay / methods
Prospective Studies
Retrospective Studies
Risk Factors
Ultrasonography, Doppler, Transcranial / methods
Reg. No./Substance:
0/Hydroxymethylglutaryl-CoA Reductase Inhibitors; 0/Lipids
Erratum In:
Arch Neurol. 2010 Jun;67(6):706

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