Abstract W P380: Asymptomatic Carotid Stenosis is Not a Walking Time Bomb
Bibliographic record
Abstract
Background & Objective: Patients with asymptomatic carotid stenosis are often persuaded to have carotid stenting or endarterectomy on the grounds that they are “walking time bombs”, headed for disaster if the artery occludes. However, this approach ignores the protection afforded by the Circle of Willis. We therefore sought to determine the risk of stroke at the time of carotid occlusion, among patients being followed in a vascular prevention clinic. Methods: Complete data were available in 386 asymptomatic patients who had a new carotid occlusion while being followed with annual carotid ultrasound examinations in our clinic. Mean followup after the occlusion was 3.42 ± 4.07 years. Percent stenosis was ≥ 80% in 60% and ≥ 90% in 53% of cases. Prior asymptomatic occlusion on the contralateral side was present in 11 cases. Mean age was 66.5 ± 10.7 years; 71.8% were male, 21% diabetic, and 24.4% still smoking prior to the occlusion. Results: Only 1 patient (0.3%) had an ipsilateral stroke at the time of the new carotid occlusion. Percent stenosis did not predict a higher risk of any stroke/TIA/death during followup in Kaplan-Meier survival analysis ( Log rank p=0.60), nor did prior contralateral occlusion at the time of the index occlusion (p=1.0). Conclusions: The risk of ipsilateral stroke at the time of carotid occlusion is well below the risk of either carotid stenting or carotid endarterectomy. Preventing carotid occlusion is not a valid indication for intervention, and percent stenosis or contralateral occlusion do not identify patients who would benefit from intervention. Patients with ACS should be treated with intensive medical therapy unless they have characteristics such as microemboli on transcranial Doppler, or other features of vulnerable plaque that identify them as high-risk.
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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 | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.010 | 0.001 |
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".