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Prognosis of Asymptomatic Carotid Artery Occlusion: Systematic Review and Meta-Analysis. BACKGROUND AND PURPOSE: The aim of this systematic review was to quantify the risk of ipsilateral stroke in patients with asymptomatic carotid artery occlusion (ACAO). METHODS: Studies reporting ipsilateral stroke risk in ACAO were identified by a search of MEDLINE, EMBASE, and study bibliographies. Study estimates were pooled using a random effects model, and heterogeneity was quantified using the I(2) statistic. The primary outcome was the annual rate of ipsilateral stroke. RESULTS: Thirteen studies were identified, encompassing 718 patients with ACAO who were followed up for a median of 2.8 years. The annual rate of ipsilateral stroke was 1.3% (95% confidence interval, 0.4-2.1; I(2)=53%). The annual rate of ipsilateral transient ischemic attack was 1.0% (95% confidence interval, 0.3-1.8; I(2)=40%). The annual rate of death was substantially higher at 7.7% (95% confidence interval, 4.3-11.2; I(2)=83%). Correction for possible publication bias for the primary outcome suggested a lower risk of ipsilateral stroke (0.3% per year; 95% confidence interval, -0.4 to 1.1). CONCLUSIONS: Stroke in ACAO is relatively infrequent, but patients face high mortality rates. This suggests the need for intensified medical therapy in ACAO.