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Screening for asymptomatic carotid stenosis in patients with peripheral vascular disease: a prospective study and
1Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, China. wkcheng@hku.hk
Insights
Screening for asymptomatic carotid artery stenosis in patients with peripheral vascular disease found a 24.7% prevalence of significant stenosis. This highlights the value of routine duplex screening, especially for elderly male smokers.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Cardiovascular Disease
Background:
- Peripheral vascular disease (PVD) is a significant risk factor for cardiovascular events.
- Asymptomatic carotid artery stenosis (ACAS) is a common comorbidity in patients with PVD.
- Early detection of ACAS can guide preventative strategies and reduce stroke risk.
Purpose of the Study:
- To determine the prevalence of ACAS in Chinese patients with PVD.
- To identify risk factors associated with significant carotid artery stenosis.
- To evaluate the utility of duplex screening in this high-risk population.
Main Methods:
- A cohort of 186 Chinese patients with PVD underwent color flow duplex scanning for ACAS screening.
- Patient demographics, smoking history, and relevant clinical data were collected.
- Logistic regression and multiple linear regression analyses were used to identify predictors of stenosis.
Main Results:
- A prevalence of 24.7% for internal carotid artery stenosis (ICAS) of 70% or greater was detected.
- ICAS was significantly associated with older age, male sex, smoking quantity and duration, and presence of a carotid bruit.
- Age, daily cigarette consumption, and carotid bruit were independent predictors of severe ICAS (> or =70%).
Conclusions:
- Routine duplex screening for ACAS is recommended in patients with PVD, particularly in elderly males and smokers.
- The presence of a carotid bruit and smoking are significant indicators of more severe carotid artery disease.
- No correlation was found between the degree of lower limb ischemia and carotid stenosis.
Abstract:
Screening for asymptomatic carotid artery stenosis using color flow duplex scan was performed on 186 Chinese patients with peripheral vascular disease. They consist of 121 male and 65 females, with a mean age of 70.6 years. A carotid bruit was present in 43 (23.1%) of the patients. Internal carotid artery stenosis of 70% or greater was detected in 46 patients (24.7%) including six total occlusions. Another 79 patients (42.5%) had internal carotid artery stenosis in the 30-69% range. Significant internal carotid artery stenosis was associated with age, male sex, the quantity and duration of smoking and a carotid bruit, and inversely with cholesterol, triglyceride and VLDL. Age, the number of cigarettes consumed per day, and carotid bruit were independent significant predictors of > or =70% internal carotid artery stenosis on logistic regression analysis. The degree of internal carotid artery stenosis is more severe in patients with a carotid bruit, and correlated positively with age (P<0.01), the number of cigarettes smoked (P = 0.04), and the duration of smoking (P = 0.03). Multiple linear regression analysis showed that only the age of the patient bears a significant relationship with the degree of internal carotid artery stenosis (P<0.01). There was no relationship between the degree of lower limb ischemia with carotid stenosis. The prevalence of > or =70% internal carotid artery stenosis in a high risk population with peripheral vascular disease was 24.7%. Routine duplex screening is worthwhile in this group of patients, particularly in male, elderly smokers.