Predicting Stroke in Patients with Asymptomatic Carotid Stenosis?

In randomized trials of carotid endarterectomy for asymptomatic carotid stenosis, surgery lowered stroke risks by only a few percentage points in men and not at all in women. Now, an international prospective observational study suggests one way to select patients most likely to benefit from surgery.

The study involved 821 patients (40% women; median age, 71) with carotid stenosis ≥50% and no history of ipsilateral stroke or transient ischemic attack. All patients underwent computed tomography brain scanning; CT findings suggestive of silent ischemic events were classified as “embolic” or “nonembolic,” according to a published classification scheme. During a mean follow-up of 45 months, 6% of patients experienced ipsilateral hemispheric stro…