Abstract Number: Esoc2026lt84 Symptomatic Carotid Outcomes Registry With Multi-Center Evaluation (Score): Interim Results

Abstract Background and aims Current treatment of symptomatic carotid stenosis relies on data that are more than 30 years old. There is limited reliable information on the stroke rate with modern, intensive medical therapy (IMT). The aim of this pragmatic registry was to provide an estimate of the ipsilateral stroke rate for patients with 50-99% symptomatic carotid stenosis who have at least one feature suggesting reduced stroke risk. Methods IMT was provided to all participants. IMT consists of dual antiplatelet therapy (short-term), high potency statins, blood pressure control, and lifestyle modification with risk factor education. Criteria for enrollment include any one of three clinical or radiologic markers. Clinical 1) Women 2) Retinal ischemic event only 3) Last symptomatic event 1 week ago. Radiologic: 1) TCD negative for emboli 2) MRI negative for intraplaque hemorrhage 3) High risk TIA with negative DWI. The primary endpoint is ipsilateral ischemic stroke within 12 months of enrollment. Results The registry completed enrollment in Sept 2025 with 114 patients (53% women), recruited from 18 centers in N America. 70% of patients qualified with stroke, 30% with TIA. All patients completed 6 month follow-up, with the ipsilateral stroke rate being 4.4%. Eight patients have died (7%). Information on stroke severity will be presented. Conclusions SCORE Registry data will allow clinicians to refine carotid stenosis decision making in symptomatic patients with 50% stenosis and potentially justify a future phase III RCT. With 6 months of follow-up in all patients, the stroke rate appears reduced compared to historical controls. Conflict of interest