Factors associated with the symptomatic status of carotid artery stenosis: identification in a cross-sectional study and development of a scoring system.

INTRODUCTION Identification of asymptomatic patients with high risk for internal carotid artery (ICA) stenosis destabilization and symptoms occurrence is important for the prognosis estimation. OBJECTIVES To identify the differences between the patients with symptomatic and asymptomatic ICA stenosis and to develop a predictive model for the risk of symptomatic stenosis based on the data accumulated in routine clinical practice. PATIENTS AND METHODS The study included 163 patients with asymptomatic and 182 patients with symptomatic ICA stenosis >70%. Comparisons between the groups were made in terms of stroke risk factors and comorbidities, coexisting ICA stenosis on the contralateral side, atherosclerosis in other arterial areas and morphology of the atherosclerotic plaque by transcervical ultrasound. RESULTS Independent risk factors for symptomatic ICA stenosis were: male sex [odds ratio (OR) 2.94, 95% confidence intervals (CI): 1.87-4.32, p 25 kg/m2 (OR 1.81, 95% CI: 1.72-1.86, p<0.001), chronic kidney disease (OR 3.34, 95% CI: 1.34-8.87, p=0.007), increased-risk features of ultrasound plaque morphology (OR 2.52, 95% CI: 1.29-3.72, p=0.009) and coexisting atherosclerosis in three or four vascular areas (OR 3.72, 95% CI: 1.77-7.23, p<0.001).The sensitivity and specificity for the scoring model created to estimate the risk of symptomatic ICA stenosis were 77.6% and 76.9%, respectively. CONCLUSIONS This cross-sectional study indicates that analysis of selected imaging and clinical parameters may allow to estimate the risk of ICA stenosis symptomatic conversion. The scoring system we propose requires further, prospective validation.