A Useful Tool for Stratifying Risk in Patients with Carotid Stenosis

With currently available medical therapy, some patients with carotid stenosis may have a low long-term stroke risk, especially those with asymptomatic stenosis. Because carotid endarterectomy and stenting carry risks such as periprocedural stroke, cardiac complications, and death, it makes sense to reserve these treatments for patients with above-average risk for stroke. One tool that could be helpful in stratifying this risk is testing intracranial vascular reactivity.

These authors performed a meta-analysis of patient-level data from nine studies that included prospective assessment of cerebrovascular reactivity (CVR) and subsequent ischemic stroke in a total of 754 patients. CVR was tested with either breath holding (3 studies) or CO₂ inh…