Prognosis of asymptomatic ulcerating carotid lesions.

To determine the proper approach to asymptomatic carotid bifurcation ulcerated plaque (UP), 79 patients with 91 asymptomatic UPs were identified angiographically, and a 96% follow-up was obtained with a mean duration of three years. The cumulative stroke rate by life-table analysis was 1% at seven years. Sixty-three UPs in 55 patients were classified as small, and of these patients, transient ischemic attacks (TIAs) that were appropriate to the lesion developed in three and stroke in one (7% cumulative symptom rate). Twenty-four UPs in 21 patients were classified as large, and a TIA developed in one patient (9%), but no strokes were observed in this group. The cumulative mortality was 17% at three years and 52% at seven years. Life-table curves of several subgroups were compared and showed no significant differences in either stroke rate or mortality between any of these groups. On the basis of these data, and particularly the seven-year stroke rate of 1%, prophylactic carotid endarterectomy is not justified for asymptomatic carotid bifurcation ulcerations.