The Natural History of Asymptomatic Extracranial Arterial Disease

The natural history of a group of 76 patients without neurologicalsymptoms, but with untreated extracranial arterial disease demonstratedby angiography 10 years ago, was studied. During this period46 patients died, and coronary artery disease was the most commoncause of death (n = 25). Six patients suffered a lethal stroke,five patients had a stroke before they died from other causesand five of the six surviving patients, who became symptomaticdeveloped TIAs, followed by a stroke in two cases, leaving onlyone who suffered a sudden stroke without premonitory warningsymptoms. Although the overall cumulative stroke rate (18 percent) was three times higher than normal, the cerebrovascularterritories affected corresponded only twice with the originalextracranial carotid lesion. Therefore, early carotid endarterectomyis inadvisable for the majority of asymptomatic patients andrepetitive non-invasive prospective study of these patientsis favoured for selection of more appropriate timing for individualtreatment.