SS04 - A score system to determine the five-year survival in patients with asymptomatic carotid stenosis under best medical therapy.

Thursday, June 11, 2026

8:00 AM - 8:11 AM ET

Location: Hynes CC, Third Level, Ballroom B

Presenting Author only(s)

Rodolfo Pini, MD, PhD

University Researcher
Vascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
Bologna, Italy

Co-Author(s)

ML

Marcello Lodato, MD

Consultant in Vascular Surgery
University of Bologna
Bologna, Emilia-Romagna, Italy

Co-Author(s)

Andrea Vacirca, MD, PhD (he/him/his)

Vascular Surgeon
University of Bologna
Bologna
Enrico Gallitto, MD, PhD

Associate Professor
Vascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
Bologna, Italy
CR

Cristina Rocchi

University of Bologna
Bologna
MG

Mauro Gargiulo

Ordinary Professor
Vascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
Bologna
CM

Chiara Mascoli, MD, PhD

Vascular Surgeon
Department of Vascular Surgery, S. Orsola-Malpighi University Hospital, Bologna, Italy.
Bologna
CP

Carmine Poliseno
BS

Betti Shyti

Bologna
MM

Marco Mattiacci

Resident
University of Bologna, Italy
PS

Paolo Spath

Vascular Surgeon, University Researcher
Department of Vascular Surgery, S. Orsola-Malpighi University Hospital, Bologna, Italy.
BOLOGNA, Emilia-Romagna, Italy

Senior Author(s)

Gianluca Faggioli, MD, PhD

Full Professor
Vascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
Bologna, Italy

Objectives: Current international guidelines do not recommend carotid revascularization in patients with asymptomatic carotid artery stenosis(ACAS) with a life expectancy less than 5 years or high-risk clinical conditions. However, improvements in medical therapy leading to a reduction of cerebral ischemic events(CIEs) risk may ameliorate overall patient survival. After a previous report of 5-year CIE outcomes in a prospective observational study of ACAS patients treated with best medical therapy (BMT), we aim to analyze the long-term survival in the same population.

Methods: This was a prospective (NCT04825080;CARAS—Carotid Asymptomatic Stenosis Study) observational cohort study including patients with ACAS>60% (NASCET criteria). Patients were not considered for carotid revascularization because of high surgical risk or the absence of plaque vulnerability features. BMT was defined as regular intake of antiplatelet therapy and statins, blood pressure control, and cessation/absence of smoking. Follow-up included annual clinical visits and six-month telephone interviews. The primary endpoint was overall survival, stratified by age ( < 80 years,81–85 years,>85 years). Secondary analyses aimed to identify independent predictors of mortality and to develop a mortality risk score.

Results: A total of 307 patients were included (mean age 80±7 years;55% male). Contralateral carotid stenosis>60% was present in 61 patients(20%). At the end of follow-up, 77% of patients were under BMT. The overall TIA/stroke rate was 1.3% / year, with higher risk for contraletaral stenosis (1.9%) and plaque progression (1.8%). The overall 5-year survival rate was 80±2%, with age-related differences: 90±2% in patients < 80 years,75±4% in those aged 81–85 years and 67±6% in patients >85 years(p <.001). Multivariable Cox regression identified diabetes mellitus(HR 2.2,95%CI 1.5–3.3;p <.001), chronic kidney disease(CKD)(HR 2.2,95%CI 1.3–3.8;p <.001), coronary artery disease(CAD)(HR 2.0,95%CI 1.3–3.0;p <.001), age 81–85 years(HR 2.5,95%CI 1.5–4.1;p <.001), and age >85 years(HR 3.5,95% CI 2.1–5.8;p <.001) as independent predictors of mortality. Based on these variables, a mortality score was developed: 1 point each for diabetes mellitus, CKD, CAD, and age 81–85 years, and 2 points for age >85 years. ROC curve analysis identified a score >3 as highly specific for patients at high risk (area under the curve: 75%). Patients with a score >3 had significantly lower 5-year survival (52%) compared with those with a score ≤3(87%;p <.001).

Conclusions: In patients with ACAS under BMT, 5-year survival is high and it is driven more by comorbid clinical conditions than by advanced age alone. These findings may help refine patient selection and risk stratification when considering carotid revascularization.