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Colour Doppler Evaluation of Extracranial Carotid Arteries: A Clinical and Radiological Correlation
Shivani Garg1, Shivali V Kashikar2, Suresh Phatak2
1Resident, Department of Radiodiagnosis, JNMC, DMIMS , Sawangi (Meghe) Wardha, Maharashtra, India .
Insights
Hypertension, smoking, and diabetes mellitus are strongly linked to carotid artery wall thickening and stenosis. These risk factors significantly increase the likelihood of atherosclerosis in older adults.
Area of Science:
- Vascular Medicine
- Cardiovascular Disease
- Diagnostic Imaging
Background:
- Atherosclerosis, characterized by arterial hardening and thickening, leads to significant vascular remodeling, blood flow obstruction, and reduced tissue oxygenation.
- Myocardial infarction and stroke, common manifestations of atherosclerosis, are leading causes of morbidity and mortality globally.
- Extracranial carotid arteries are crucial for blood supply to the brain, making their assessment vital in patients with atherosclerosis risk factors.
Purpose of the Study:
- To evaluate the prevalence of atherosclerosis, hemodynamic, and morphological changes in the extracranial carotid arteries of patients with atherosclerosis risk factors.
- To determine the association between specific risk factors (Diabetes Mellitus, Hypertension, Smoking, Stroke, Coronary Artery Disease, Hypercholesterolaemia) and carotid abnormalities.
- To analyze the correlation between age, sex, and the severity of carotid artery stenosis.
Main Methods:
- A prospective, cross-sectional analytical study involving 1043 patients aged over 60 years over a two-year period (2013-2015).
- Duplex ultrasound was employed to examine the extracranial carotid arteries, assessing common carotid artery intima-media thickness (CCA-IMT), internal carotid artery intima-media thickness (ICA-IMT), and percent stenosis.
- Statistical analysis, including multiple logistic regression and analysis of variance, was used to correlate risk factors with carotid artery measures (p<0.05).
Main Results:
- Stenosis prevalence and severity increased with age, with mild stenosis (<50%) being more common than severe stenosis (>70%).
- Men exhibited higher prevalence and severity of stenosis compared to women across all age groups.
- Hypertension demonstrated the strongest positive correlation with CCA-IMT, ICA-IMT, and maximum percent stenosis. Stroke history, smoking, diabetes mellitus, hypercholesterolaemia, and heart disease were also significantly associated with carotid abnormalities, particularly at the carotid bifurcation.
Conclusions:
- Common carotid artery intima-media thickness (CCA-IMT) showed strong associations with hypertension, smoking, and diabetes mellitus.
- Internal carotid artery intima-media thickness (ICA-IMT) was significantly linked to hypertension and a history of heart disease.
- The degree of percent stenosis in the carotid arteries was strongly associated with smoking and a history of heart disease.
Introduction:
Atherosclerosis (i.e. hardening and thickening of arteries) causes vascular remodeling, obstruction of lumen, abnormalities of blood flow and reduced oxygenation of target tissues. Manifestation of atherosclerosis in the form of either Myocardial Infarction or Stroke is the major cause of morbidity and mortality. This study evaluated extracranial carotid arteries of patients (>60 years) who presented with risk factors of atherosclerosis and determined the association of risk factors with carotid abnormalities.
Aim:
To evaluate the prevalence of atherosclerosis, haemodynamic and morphological changes that take place in extra cranial portion of carotid arteries in patients with risk factors of atherosclerosis (Diabetes Mellitus, Hypertension, Smoking, Stroke, Coronary Artery Disease, Hypercholesterolaemia) and determine the association of risk factors with carotid abnormalities.
Materials And Methods:
The prospective cross-sectional analytical study included the examination of Extracranial carotid arteries of 1043 patients over a period of 2 years (2013-2015) using duplex ultrasound. Assessment of CCA-IMT, ICA-IMT and percent stenosis was done using a linear probe of 8-12 MHz.
Statistical Analysis:
Correlation between risk factors of atherosclerosis, wall thickness of common carotid (CCA-IMT), internal carotid arteries (ICA-IMT) and stenosis was studied using statistical tools like multiple logistic regression analysis and analysis of variance (p<0.05) using SPSS 17.0.
Results:
Maximum percent stenosis increased with increase in age. Prevalence of severe stenosis (>70%) was low while the prevalence of mild stenosis (<50%) was quite high. In all age groups, stenosis was more prevalent and more severe in men as compared to women. Hypertension showed the strongest positive correlation with all three measures of interest CCA-IMT, ICA-IMT and maximum percent stenosis. Stroke history showed strong positive correlation with CCA-IMT and stenosis. Smoking, Diabetes Mellitus, Hypercholesterolaemia, Heart disease showed strong association with all three measures as well. Atherosclerotic plaques were mostly found at the site of carotid bifurcation.
Conclusion:
CCA-IMT was strongly associated with hypertension, smoking and diabetes mellitus. ICA-IMT was strongly associated with hypertension and history of heart disease. Percent stenosis was strongly associated with smoking and history of heart disease.
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