Primary Stroke Prevention -
Management of Carotid Artery Stenosis

Carotid artery stenosis is an important cause of ischemic strokes but is also an important marker of atherosclerotic vascular disease and risk of myocardial infarction (MI) and vascular death.  Approximately 4% of the population over the age of 50 harbor asymptomatic carotid artery stenosis of at least 50% . Current treatment options include medical therapy with or without carotid revascularization with carotid endarterectomy (CEA) or carotid artery stenting (CAS). In the significant proportion of patients that are labeled “high surgical risk”, long-term survival and stroke risk reduction must be especially favorable in order for revascularization to be of benefit. Although CAS was recently shown to have a better safety profile than CEA for high-risk patients in the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) trial , whether revascularization is superior to medical therapy alone for the asymptomatic high-risk subgroup is unknown. Because of this, the Centers for Medicare and Medicaid Services (CMS) recently decided not to reimburse CAS in asymptomatic high-risk patients and there has been a call for further research on this issue.

SORP researchers, together with investigators from Kaiser Permanente, are studying this important clinical problem and obtain data to guide decision-making for patients with carotid artery stenosis. We are performing a two-year retrospective cohort study of 500 subjects in the Kaiser Permanente healthcare system who have been identified as having high-grade asymptomatic carotid artery stenosis by ultrasound, and who have at least one high-surgical-risk criterion.