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Extracranial carotid arterial disease: a prognostic factor for atherothrombotic brain infarction and cerebral
W S Aronow1, C Ahn, M Schoenfeld
1Hebrew Hospital Home, Bronx, NY 10475.
Insights
Severe carotid artery disease significantly increases stroke risk. This study found that 80%-100% carotid stenosis correlated with a 2.5x higher risk of atherothrombotic brain infarction.
Area of Science:
- Neurology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Extracranial carotid arterial disease is a significant risk factor for cerebrovascular events.
- Understanding the correlation between carotid stenosis severity and stroke incidence is crucial for patient management.
Purpose of the Study:
- To investigate the prevalence of extracranial carotid arterial disease.
- To evaluate the correlation between carotid stenosis severity and the incidence of atherothrombotic brain infarction (ABI) and transient ischemic attack (TIA).
Main Methods:
- Prospective study involving 949 patients (mean age 82 years).
- Carotid duplex ultrasonography used to assess carotid arterial disease.
- Follow-up period of 45 months to track ABI and TIA incidence.
Main Results:
- 4% of patients had 80%-100% carotid stenosis, 12% had 40%-80%, and 84% had 0%-40%.
- Annual incidence of ABI was 37% (80%-100% stenosis), 9% (40%-80%), and 4% (0%-40%).
- Severity of carotid disease correlated with highest relative risk for ABI (2.5x) and TIA (2.8x).
Conclusions:
- Extracranial carotid disease severity is a significant predictor of atherothrombotic brain infarction and transient ischemic attack.
- Earlier stroke history and patient demographics like age and sex are also prognostic variables.
Abstract:
A prospective study investigated the prevalence of extracranial carotid arterial disease by carotid duplex ultrasonography, and evaluated its correlation with the incidence of atherothrombotic brain infarction or cerebral transient ischemic attack in 949 patients, mean age 82 +/- 8 years. The mean follow-up period was 45 months. Of 949 patients, 37 (4%) had 80%-100% extracranial carotid disease (mean follow-up, 24 +/- 15 months), 113 (12%) had 40%-80% extracranial carotid disease (40 +/- 19 months follow-up), and 799 (84%) had 0%-40% extracranial carotid disease (47 +/- 14 months follow-up). The average annual incidence of atherothrombotic brain infarction was 37% in patients with 80%-100% extracranial carotid disease, 9% in patients with 40%-80% extracranial carotid disease, and 4% in patients with 0%-40% extracranial carotid disease. The average annual incidence of transient ischemic attack was 3% in patients with 80%-100% extracranial carotid disease, 2% in patients with 40%-80% extracranial carotid disease, and 1% in patients with 0%-40% extracranial carotid disease. The Cox proportional hazard model showed that among the variables evaluated, the severity of extracranial carotid disease correlated with the highest relative risk of developing atherothrombotic brain infarction (2.5x higher relative risk) or transient ischemic attack (2.8x higher relative risk). Patients with an earlier atherothrombotic brain infarction had a 2.1x higher probability of developing atherothrombotic brain infarction and a 1.9x higher chance of developing transient ischemic attack than those without an earlier atherothrombotic brain infarction. Age was a prognostic variable for new atherothrombotic brain infarction, and male sex was a prognostic variable for new transient ischemic attack.