{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T06:32:27Z","timestamp":1790663547850,"version":"4.1.0"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Carotid endarterectomy for symptomatic carotid stenosis is based on decades-old trials, while modern medical therapy has substantially improved outcomes. The carotid artery risk (CAR) score predicts stroke risk using clinical and imaging factors. This study evaluates the 2-year risk of recurrent ipsilateral stroke in patients with recent transient ischemic attack, amaurosis fugax, or minor stroke and ipsilateral symptomatic carotid stenosis treated with intensive medical therapy.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>In this prospective, single-arm observational study conducted in Denmark from October 2020 to March 2023, we enrolled 109 patients with recent TIA, amaurosis fugax, or minor stroke and 50% to 99% ipsilateral symptomatic carotid stenosis. Patients with a CAR score \u226420% or &gt;20%, as well as those with contraindications to surgery, were included. All received intensive medical therapy. The primary outcome was ipsilateral recurrent stroke or death within 2 years.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              The mean age was 73 years; 60% were male patients. Six patients (5.5%) experienced ipsilateral recurrent stroke, representing a \u224875% reduction compared with historical NASCET (North American Symptomatic Carotid Endarterectomy Trial) rates (\u224823%). Patients with CAR score \u226420% (n=96) had a significantly lower 2-year stroke rate (3.1%) than those with CAR score &gt;20% (n=13; 23%;\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.02). The CAR score \u226420% subgroup showed high predictive accuracy: sensitivity of 0.90, specificity of 0.50, and positive predictive value of 0.97.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>In this observational study, modern medical therapy was associated with low rates of recurrent stroke in patients with symptomatic carotid stenosis. Patients with a CAR score \u226420% had a very low risk of recurrent stroke, suggesting that selected patients may be managed conservatively.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.125.052151","type":"journal-article","created":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T09:00:34Z","timestamp":1754557234000},"page":"3072-3077","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["CASCOM Study: CAR Score Predicting Restroke in Symptomatic Carotid Stenosis With Only Intensive Medical Therapy"],"prefix":"10.1161","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3211-7241","authenticated-orcid":true,"given":"Saeid","family":"Shahidi","sequence":"first","affiliation":[{"name":"Department of Vascular and Endovascular Surgery (S.S., E.N.E., M.B., A.P., S.A.Z.), Zealand University Hospital, Roskilde, Denmark."},{"name":"Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen and Zealand, Denmark (S.S., T.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5389-1105","authenticated-orcid":true,"given":"Troels","family":"Wienecke","sequence":"additional","affiliation":[{"name":"Department of Neurology (T.W.), Zealand University Hospital, Roskilde, Denmark."},{"name":"Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen and Zealand, Denmark (S.S., T.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilie","family":"Noeddeskov Eilersen","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery (S.S., E.N.E., M.B., A.P., S.A.Z.), Zealand University Hospital, Roskilde, Denmark."},{"name":"Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark (E.N.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1697-3598","authenticated-orcid":true,"given":"Magdalena","family":"Broda","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery (S.S., E.N.E., M.B., A.P., S.A.Z.), Zealand University Hospital, Roskilde, Denmark."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Pelta","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery (S.S., E.N.E., M.B., A.P., S.A.Z.), Zealand University Hospital, Roskilde, Denmark."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3897-6474","authenticated-orcid":true,"given":"Stefan Andreas","family":"Zambach","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery (S.S., E.N.E., M.B., A.P., S.A.Z.), Zealand University Hospital, Roskilde, Denmark."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2021.04.073"},{"key":"e_1_3_3_3_2","unstructured":"National Institute for Health and Care Excellence (NICE). Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. NICE guideline [NG128]. Accessed July 15 2025. https:\/\/www.nice.org.uk\/guidance\/ng128"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2022.04.011"},{"key":"e_1_3_3_5_2","unstructured":"Lomholt M Cikotas A Shahidi SH Shilenok D Lindholt J Rathenborg LK. Danish national guidelines for carotid stenosis treatment 5. version 2022. 2019. 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Optimised medical therapy alone versus optimised medical therapy plus revascularisation for asymptomatic or low-to-intermediate risk symptomatic carotid stenosis (ECST-2): 2-year interim results of a multicentre randomised trial. Lancet Neurol. 2025;24:389\u2013399. doi: 10.1016\/S1474-4422(25)00107-3","DOI":"10.1016\/S1474-4422(25)00107-3"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/s1474-4422(25)00107-3"},{"key":"e_1_3_3_16_2","unstructured":"Danish Neurological Society. Danish National Neurologic Guidelines for ischemic stroke and transient ischemic attack (NNBV). 2019. 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