The effectiveness of the prevention measures on stroke incidence in patients with ipsilateral carotid disease

Background: The aim of this study is to assess the possible causes of cerebral ischemic events for ipsilateral carotid stenosis in the era of the best medical therapy. Methods: This is a retrospective and observational study conducted on patients entered into stroke protocol and subsequently underwent carotid endarterectomy (CEA) for ipsilateral stenosis at the University-Hospital of Ferrara. A 4-year period of time (January 2014 to December 2017) was investigated and demographic data, comorbidities, current medical therapies and instrumental examinations performed prior hospitalization were collected. Results: We identified 78 patients who underwent CEA for symptomatic carotid stenosis. The mean age was 62 (range 52 to 76), 64.1% were male. Among those, 20% presented with acute internal carotid occlusion, 60% had a stenosis >90%, 14% between 70-90%, 6% of 60-69% and 32% had a contralateral stenosis >60%. Moreover, 82.4% of them were not aware of having carotid stenosis since they had never been assessed with duplex ultrasound. Among these patients 49% were not under antiplatelet/anticoagulant medication, 46 patients had systemic hypertension but untreated in 74.5% of them, 31 patients had dyslipidemia without taking statin-therapy in 66.7% of cases, 35 patients had hyperglycemia but untreated in 70% as confirmed measuring glycated hemoglobin and 52.9% were smokers. Among patients who were aware of having hemodynamic carotid stenosis, 33% of them was documented a scarce adherence to the medical therapy and 22% was not set up an adequate one. Conclusions: The non-diagnosed carotid stenosis and insufficient medical treatment due to uninvestigated cardiovascular diseases revealed to be frequent in patients with symptomatic carotid stenosis. This suggests that more should be done to enrich the screening strategies in order to offer better prevention from cardiovascular events.