Carotid artery stenosis - hemodynamic significance and clinical course

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Abstract
Patients (215) with a history of either stroke, transient ischemic attack (TIA) or asymptomatic carotid bruit underwent noninvasive carotid artery testing using oculopneumoplethysmography. Of patients with hemodynamically significant stenosis, 51 (40.8%) underwent endarterectomy; 74 (59.2%) were treated nonoperatively. The incidence of stroke in the nonoperated group was 12/74 (16.2%) compared with only 1/51 (1.9%) in the operated group. Recurrent TIA occurred in 29/74 (39.2%) of the nonoperated group vs. 9/51 (17.6%) of the operated. In nonhemodynamically significant carotid stenosis, the risk of cerebrovascular death and stroke was exceedingly low: 2/90 (2.2%). Patients with hemodynamically significant stenosis treated nonoperatively have a greater risk of cerebrovascular death, stroke and TIA than patients treated with carotid endarterectomy.