Abstract W P353: Benign Natural History of Occlusion in Asymptomatic Carotid Stenosis
Bibliographic record
Abstract
Introduction: One commonly stated reason for stenting of asymptomatic carotid stenosis is to prevent carotid occlusion. However, the Circle of Willis provides substantial protection against occlusion, so this objective may be misguided. In the NASCET trial, patients with near occlusion of the internal carotid had a lower risk of stroke than did patients with lesser degrees of stenosis. We studied the effects of progression to occlusion among patients with asymptomatic stenosis of the internal carotid artery (ICA). Methods: We studied the outcome of all consecutive patients in our clinic database with asymptomatic carotid stenosis of ≥60% at baseline between 1991 and 2010, who were followed for at least two years with carotid ultrasound and clinical evaluation. Results: 370 patients were included; mean age ± SD 68.8 ± 10.3; 210 (56.8%) were men. Systolic blood pressure was 149.8 ± 22.2, low-density lipoprotein 2.3 ± 1.1 mmol/L, smoking pack-years 24.5 ± 23.3. Only one individual (0.03%) with near occlusion of the ICA developed a new ipsilateral internal carotid artery (ICA) occlusion within a year. This patient experienced episodes of ipsilateral amaurosis fugax before the occlusion (which occurred after he was referred for endarterectomy), but remained asymptomatic after the ICA was totally occluded. Conclusion: Occlusion of asymptomatic carotid stenosis is a rare and usually benign occurrence. In patients with asymptomatic carotid stenosis. The risk of stroke from carotid occlusion is well below the risk of stroke from stenting. Preventing ICA occlusion is not a valid reason to perform carotid stenting in patients with asymptomatic carotid stenosis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".