Highlights
- •Degree of stenosis was not associated with the event recurrence in ESCS patients.
- •OMT was beneficial for most ESCS patients during one year follow-up.
- •CaroTID-VasC score was effective in stratifying patients for risk of event recurrence.
- •CaroTID-VasC score is a pragmatic, easy-to-use tool for predicting the annual risk of event recurrence in ESCS patients.
Abstract
Background
A subset of extracranial symptomatic carotid stenosis (ESCS) patients may fare well
on current optimal medical therapy (OMT), and surgery may be avoided in these patients.
Therefore, we aimed to develop and validate a stroke risk prediction model to stratify
the risk among ESCS patients.
Methods
Adult ESCS patients who denied revascularization procedures were enrolled prospectively
and prescribed OMT. Patients were followed-up for twelve months after assessing the
clinical, imaging, and hemodynamics-based risk predictors at baseline. Cox regression
analysis was performed on predictors which were significant in univariate analysis.
Beta coefficients of significant predictors in Cox regression were used to generate
a numeric score. The model was internally validated using bootstrapping.
Results
A total of 20 (20.2%) out of 99 patients had event recurrence during the follow-up.
Transient ischemic attack index event (P = 0.014), diabetes mellitus (P = 0.018), contralateral significant stenosis (P = 0.007), echolucent plaque (P = 0.011), and impaired vasomotor reactivity (P = 0.006) were significant predictors in Cox regression analysis. A points score (0–6)
was derived from regression coefficients of the significant predictors. The area under
ROC was 0.884 for the developed model and 0.832 for the bootstrapped model. Youden's
index divided the score into low-risk (2.2%) and high-risk (35.8%) groups, and the
difference in risk was significant (P < 0.001).
Conclusions
Most ESCS patients benefited from OMT, and the CaroTID-VasC score was effective in
stratifying patients for risk of endpoint occurrence. The developed model may help
identify high-risk subgroups of ESCS patients and assist the decision-making of carotid
interventions.
Keywords
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Article info
Publication history
Published online: January 30, 2023
Accepted:
January 27,
2023
Received in revised form:
January 22,
2023
Received:
December 22,
2022
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
