Minority of patients in population of 4M demonstrate rapid progress of carotid stenosis, SAVS prize-winning paper finds

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Carney Chan (center)

PALM BEACH, Fla.—While the overall incidence of rapid carotid stenosis progression is low, patients who show any degree of a worsening condition may warrant closer follow- up—especially if they bear associated risk factors for such rapid progress.

That was a core conclusion of the 2020 Founders’ Award paper presented by Carney Chan, MD, at the Southern Association for Vascular Surgery (SAVS) annual meeting held in Palm Beach, Florida, Jan. 8–11.

Entitled “Rapid progression of carotid stenosis is rare in a large integrated healthcare system over an eight-year period,” Chan and colleagues aimed to examine the natural progression of the condition, identify a subset of patients with rapid development of the stenosis and evaluate specific risk factors.

Each year, the SAVS Founders’ Award recognizes trainees presenting papers of either original, clinical or basic science at the association’s annual meeting, with Chan, a fellow at the Ochsner Clinic in New Orleans, collecting his award at the close of his presentation from William Jordan, MD, SAVS secretary/treasurer, and Adam Beck, MD, the 2020 SAVS meeting program chair. By way of background Chan et al pointed out the current Society for Vascular Surgery guidelines suggest screening for asymptomatic carotid stenosis in a select group of high-risk patients. The researchers said there was “a paucity of data” on rapid progression on a large scale. They identified patients in a large integrated health system who had received two or more carotid duplex ultrasounds for stenosis between August 2010 and August 2018, using a novel algorithm to identify which of them displayed the rapid progression and, additionally, to determine associated risk factors and comorbidities.

An electronic data warehouse bearing 4 million unique patients for all carotid ultrasounds was accessed. Filtering saw the retention only of those patients with two or more examinations.

Sharing their results, Chan noted: “With an initial cohort of over 4 million patients, the algorithm identified 4,982 with two or more duplex ultrasounds,” and this involved 10,037 carotid arteries having undergone 29,363 ultrasounds.

“Over the course of the study, 4,103 (82.4%) patients did not show any progression,” he said, “while 879 (17.6%) patients had some level of progression.

“We found 639 (12.8%) patients progressed one level, 164 (3.3%) two levels, 50 (1%) three levels and 26 (0.5%) progressed four levels. Of those that progressed, 116 (2.3%) progressed to level four (80– 99% stenosis) from any starting level over a median time of 11.5 months, with an average starting level of 2.1 (40–59% stenosis).

Summing up, Chan pointed out that the 17.6% who showed some degree of progression statistic was consistent with prior studies but that only 3.6% were rapid. “We identified younger age, Caucasian race, lower BMI [body mass index], diagnosis of PAD [peripheral arterial disease] and diagnosis of TIA [transient ischemic attack] as risk factors for rapid progression,” they found. “Lastly, while EMRs [electronic medical records] have been linked with physician burnout, we demonstrated appositive and novel use of this technology to understand the natural history of the diseases, as this approach could be applied for other disease processes.”

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