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Risk factors in asymptomatic patients with a carotid bruit
F L Moll1, B C Eikelboom, F E Vermeulen
1Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
Insights
Ocular Pneumoplethysmography (OPG) helps identify asymptomatic carotid bruit patients at risk for stroke. High blood pressure, diabetes, and heart disease are key risk factors for carotid artery disease progression.
Area of Science:
- Vascular Surgery
- Neurology
- Diagnostic Imaging
Background:
- Asymptomatic carotid bruit is a common finding.
- Identifying patients at risk for cerebrovascular events is crucial.
Purpose of the Study:
- To prospectively evaluate Ocular Pneumoplethysmography (OPG) in asymptomatic patients with carotid bruit.
- To identify individuals prone to cerebrovascular ischemia or carotid disease progression.
Main Methods:
- Prospective follow-up of 369 asymptomatic patients with carotid bruit.
- Utilized Ocular Pneumoplethysmography (OPG) for non-invasive assessment.
- Monitored for stroke, transient ischemic attacks (TIAs), and carotid stenosis progression.
Main Results:
- 13 strokes and 15 TIAs occurred during follow-up.
- TIA risk was higher with hemodynamically significant stenosis (9%) vs. normal OPG (2%).
- Carotid stenosis progression reached 18% at 2 years and 56% at 5 years.
Conclusions:
- OPG, combined with physical examination, can identify high-risk patients with asymptomatic carotid bruit.
- Systolic blood pressure >160 mmHg, diabetes, and ischemic heart/peripheral arterial disease are major risk factors for disease progression.
Abstract:
A consecutive series of 369 asymptomatic patients with a carotid bruit was prospectively followed with Ocular Pneumoplethysmography (OPG). The aim of the study was to identify those patients most prone to cerebrovascular ischemia and/or progression of obstructive carotid disease. During follow-up 13 patients developed a stroke of which six were fatal (two thrombo-embolic and four haemorrhagic strokes). TIA's occurred in 15 patients, including eight patients with amaurosis fugax. TIA's occurred more frequently on the side of a haemodynamically significant stenosis (9% = 9/95) than on the side of a normal, OPG (2% = 6/274). There was no difference in the strokelocated side. The occurrence of symptoms and/or signs of cerebrovascular disease was 4% at two years and 10% at five years. The left hemisphere was affected twice as often as the right. The development of a haemodynamically significant carotid stenosis, according to OPG, was equal for the right and the left carotid arteries, being 18% at two years and 56% after 5 years of follow-up. The major risk factors for progression of obstructive disease were systolic blood pressure above 160 mmHg independent of age, diabetes mellitus and the presence of ischaemic heart and peripheral arterial obstructive disease. This study supports the contention that in a group of patients with an asymptomatic carotid bruit, a group of patients at risk from cerebrovascular accidents can be filtered out by a simple non-invasive test in combination with a complete physical examination.