According to the American Heart Association scientific statement on the primary prevention of ischemic stroke, this patient has an estimated annual risk of stroke of 1% to 2% (Goldstein, 2001). The Toronto Asymptomatic Cervical Bruit Study prospectively followed a cohort of 500 asymptomatic patients with cervical bruits for a mean of 23 months (Chambers, 1986). The overall incidence of stroke at one year was 1.7% (1% in patients without previous TIAs); however, the incidence was 5.5% in patients with severe carotid artery stenosis (>75%). Cerebral ischemic events (TIA or stroke) occurred most frequently in men (P <0.025) and in patients of either sex with a history of severe carotid artery stenosis (P <0.0001), progressing carotid artery stenosis (P <0.0005), or heart disease (P <0.0005).
Additional observational studies such as the NASCET study suggest that the overall rate of underreported stroke ipsilateral to a hemodynamically significant extracranial carotid artery stenosis is 1% to 2% annually.
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