Demographic profile, patterns of management and outcome in patients with severe carotid stenosis at St. Lukes Medical Center.

BACKGROUND AND OBJECTIVE: Carotid artery stenosis is considered as one of the most important risk factors for stroke. Although carotid endarterectomy (CEA) has been a topic of emotional debate and uncertainty, clinical trials showed favorable benefit in preventing recurrent strokes among patients with severe carotid stenosis. The objective of our study is to evaluate the demographic profile, patterns of management, and outcome of patients with severe carotid stenosis at St. Lukes Medical Center
METHODS: We reviewed the records of all patients with severe carotid stenosis (70 percent) by carotid doppler studies done at the Non-invasive Vascular Laboratory of St. Lukes Medical Center from January 1997 to April 2000. We ascertained information on the degree of stenosis, side of stenosis and stroke, risk factors, medications given, date of CEA if done, and reasons why CEA was not done. We followed up all the patients by reviewing all records available and by interview through telephone or mail. Data were analyzed and presented as means and percentage distribution
RESULTS: A total of 6,851 carotid Doppler studies performed at the non-invasive vascular laboratory over the 40-month period were reviewed. One hundred seven (1.5 percent) patients diagnosed with severe carotid artery stenosis were included in the study. Mean age was 69.5 years (range 29 to 92 years) with men comprising 61 percent. Severe stenosis was slightly more often seen in the right carotid (53 percent). The most common risk factors were hypertension (62 percent), smoking (45 percent), excessive alcohol intake (32 percent), diabetes (29 percent), MI and AF (14 percent), and hyperlipidemia (9 percent). Most of the patients 64 (71 percent) have 2 or more risk factors, 22 (24 percent) had a single risk factors and only 4 (4 percent) had no risk factor. Most of the patients managed medically were prescribed ticlopidine (42 percent), aspirin (36 percent) and combination of ticlopidine and aspirin (15 percent). One third (33 percent) were seen by a neurologist alone, while others were seen by both cardiologist and neurologist (29 percent) and by a cardiologist alone (25 percent). Of the 107 patients, 44 (41 percent) were symptomatic, of whom 13 (30 percent) were offered CEA but only 6 (14 percent) underwent surgery. Among the asymptomatic patients (n=63; 59 percent), 11 (17 percent) were offered CEA but again only 7 (11 percent) underwent CEA. Among those who underwent CEA 9 (70 percent) were males. Four (4 percent) of the patients expired during the course of the hospital stay. At 6 months, 12 months and 24 months follow-up, occurrence of new stroke myocardial infarction and death were noted in 11 (14 percent), 16 (23 percent), and 20 (32 percent) of patients, respectively. All strokes and deaths on follow-up occurred in the non-CEA group. Twenty four percent had no follow up for different reasons
CONCLUSIONS: While severe carotid stenosis was detected in only a small number of patients who underwent carotid duplex studies, it is often associated with multiple risk factors. CEA as a treatment option was not often offered, and much less performed in our local setting. Stroke occurrence in 24 months was significantly lower among the surgical group. Neither stroke nor mortality was noted among those who underwent CEA. (Author)