Symptomatic carotid near‐occlusion with full collapse might cause a very high risk of stroke

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>The risk of early stroke recurrence amongst patients with symptomatic carotid near‐occlusion with and without full collapse is unknown. Therefore, the aim of this study was to analyse the 90‐day risk of recurrent ipsilateral ischaemic stroke in patients with symptomatic carotid near‐occlusion both with and without full collapse.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This study was a secondary analysis of the Additional Neurological <jats:styled-content style="fixed-case">SY</jats:styled-content>mptoms before Surgery of the Carotid Arteries: a Prospective study (<jats:styled-content style="fixed-case">ANSYSCAP</jats:styled-content>). We prospectively analysed 230 consecutive patients with symptomatic 50–99% carotid stenosis or near‐occlusion. Based on the combination of several imaging modalities, 205 (89%) patients were classified as having 50–99% carotid stenosis, and 10 (4%) and 15 (7%) as having near‐occlusion with and without full collapse, respectively. The 90‐day risk of recurrent ipsilateral ischaemic stroke was compared between these three groups. Only events that occurred before carotid endarterectomy were analysed.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The 90‐day risk of recurrent stroke was 18% [95% confidence interval (<jats:styled-content style="fixed-case">CI</jats:styled-content>) 12–25%; <jats:italic>n</jats:italic> = 29] for patients with 50–99% carotid stenosis, 0% for patients with near‐occlusion without full collapse and 43% (95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 25–89%; <jats:italic>n</jats:italic> = 4) for patients with near‐occlusion with full collapse (<jats:italic>P</jats:italic> = 0.035, log‐rank test). The increased risk of recurrent ipsilateral ischaemic stroke for patients with symptomatic near‐occlusion with full collapse remained significant after multivariable adjustment for age, sex and type of presenting event.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Patients with symptomatic carotid near‐occlusion with full collapse might have a very high risk of stroke recurrence. Carotid endarterectomy could be considered for these patients.</jats:p></jats:sec>