Silent Ischemia and Clinical Manifestations in a Cohort of Asymptomatic Carotid Stenosis Patients According to Stenosis Degree

Background: Asymptomatic carotid plaques (ACP) generating less than 70% stenosis still have risk of complications.Our objective was to compare the incidence of silent lesions (SL) in patients with moderate stenosis (50-70%), severe stenosis (70-99%) or carotid occlusion, as well as the incidence of ipsilateral ischemic stroke or transient ischemic attack (TIA) during follow-up Material and method: cohort study of patients with carotid stenosis >50% by Doppler. LS were evaluated by MRI at admission and the end-points were ischemic stroke or TIA during follow-up. The study was approved by the Ethics Committee. Results: 646 patients were included from June 2010 to June 2018, 25% with bilateral stenosis >50%. Mean age 75 (ICR 53-79), 54% female. Sixty-three percent (n 507) had stenosis 70-99%, 31% (n 250) stenosis 50-70% and 6% (n 50) had carotid occlusion. SL were present in 15% (n 119) of the 807 plaques evaluated. Only limitrofe lesions were more prevalent in patients occlusion when comparing with severe and moderate stenosis:(20% vs 2% vs 1%, respectively; p 0.02 (table). Four patients had minor ipsilateral stroke (NIHSS < 5) during follow-up and 8 TIA; endarterectomy was performed in all of them. Clinical events did not occur in carotid occlusion, 3% (n 8) in moderate stenosis and 1% (n 4) in severe stenosis. Conclusion: SL incidence was not different in different stenosis degree, except for limitrofe infarcts in carotid occlusion (probably due to hemodynamic effect). Incidence of cerebrovascular complications was similar in patients with moderate and severe stenosis.