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P5: Plenary Session 5

SS12 - Progression of Carotid Stenosis Among U.S. Veterans

Friday, June 6, 2025
8:00 AM – 8:11 AM CT
Location: Morial CC, First Floor, Great Hall A

    Submitting & Presenting Author(s)

  • Naveen Balasundaram, MBBS

    Assistant Professor
    University of Missouri
    Philadelphia, Pennsylvania

    Slides

    • Co-Author(s)

  • MY

    Ming Yin

    VA Informatics and Computing Infrastructure, VA Salt Lake City Healthcare System

  • KL

    Kyung Min Lee

    Data Scientist
    VA Informatics and Computing Infrastructure, VA Salt Lake City Healthcare System
    Salt Lake City, Utah

  • KH

    Katherine Hartmann

    Department of Radiology, University of Pennsylvania

  • GB

    Gina M. Biagetti

    Hospital of the University of Pennsylvania
    Philadelphia, Pennsylvania

  • GS

    Gabrielle Shakt

    Corporal Michael Crescenz VA Medical Center

  • Michael G. Levin, MD

    Assistant Professor
    Corporal Michael Crescenz VA Medical Center
    Philadelphia, Pennsylvania

  • PA

    Patrick Alba

    VA Informatics and Computing Infrastructure, VA Salt Lake City Healthcare System

  • JL

    Julie Lynch

    VA Informatics and Computing Infrastructure, VA Salt Lake City Healthcare System

    • Senior Author(s)

  • SD

    Scott M. Damrauer, MD

    Associate Professor
    Corporal Michael Crescenz VA Medical Center, Philadelphia, PA
    Philadelphia, Pennsylvania

Objectives: Carotid Stenosis is a well-recognized risk factor for stroke yet screening guidelines and management of asymptomatic patients remain controversial. This study was designed to evaluate the progression of patients with mild carotid stenosis based on non-invasive duplex imaging.

Methods: All veterans who received a carotid duplex recorded in the Veterans Health Administration (VHA) electronic health record between 2001 and 2020 were analyzed. Internal carotid to Common carotid Ratio (ICA/CCA ratio) was extracted using NLP (natural language processing algorithm). Patients who had carotid intervention or symptoms prior to their first duplex, had ICA/CCA ratio >=2 at index, or who no follow up duplex were removed. Survival analysis with outcome of progression to ICA/CCA ratio >4 was performed. Cox regression was used to adjust for sociodemographic variables and traditional vascular risk factors.

Results: There were 1 120 167 duplexes available for analysis. After exclusions, an index duplex was identified for 107 137 patient-sides, out of which 3854 (3.6%) were in females, 91 991 (85%) were in White Veterans, 7608 (7.1%) were in Black Veterans. The median age was 67 years. The median follow up (time to last duplex) was 4.0 years. At the 5-year mark, 10 864 patients (10.14%) had progressed to ICA/CCA ratio >2 and only 1013 patients (0.94%) had progressed to ICA/CCA ratio >4 (Fig1). Higher baseline ratio (p < 0.001, HR=8.7), HT (p = 0.005, HR = 1.7), CAD (p < 0.001, HR = 1.2), smoking (p < 0.001, HR= 2.0) are associated with significant differences in progression

Conclusions: For patients who are identified to have carotid stenosis with ICA/CCA ratio < 2 and their risk factors are optimized, there was minimal progression to critical carotid stenosis (ratio>4) over a 5 year period