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Asymptomatic carotid bruit and stenosis. A prospective follow-up study
Insights
Asymptomatic carotid stenosis with bruit is more likely to cause transient ischemic attacks (TIAs) than cerebral infarction. Myocardial infarctions are more frequent and deadly in these patients.
Area of Science:
- Cardiology
- Neurology
- Vascular Surgery
Background:
- Asymptomatic carotid bruits can indicate underlying carotid artery stenosis.
- Carotid artery stenosis is a risk factor for cerebrovascular and cardiovascular events.
Purpose of the Study:
- To investigate the association between asymptomatic carotid stenosis and ischemic events.
- To compare the incidence of cerebral versus myocardial ischemic events in patients with asymptomatic carotid bruit and stenosis.
Main Methods:
- Observational study of 70 patients with asymptomatic carotid bruits.
- Assessment of carotid stenosis severity.
- Monitoring for cerebral and myocardial ischemic events.
Main Results:
- Four transient ischemic attacks (TIAs) occurred, all distal to stenoses >= 50%.
- Three cerebral infarctions occurred, with only one distal to a significant stenosis.
- Six myocardial infarctions occurred, more common in patients with prior cardiac conditions.
Conclusions:
- Asymptomatic carotid stenosis is more frequently complicated by TIAs than cerebral infarction.
- Cerebral infarctions in this cohort were often unrelated to the carotid lesion.
- Myocardial infarctions are more common and a more frequent cause of death than cerebral infarctions in patients with asymptomatic carotid stenosis.
Abstract:
We observed 70 patients with asymptomatic carotid bruits with and without stenoses for cerebral and myocardial ischemic events. Four patients developed transient ischemic attacks (TIAs) without subsequent cerebral infarctions; all of the TIAs occurred distal to vessels with greater than or equal to 50% stenoses. Three cerebral infarctions occurred, but only one was distal to a vessel with stenosis greater than or equal to 50%. Six myocardial infarctions occurred, predominantly in patients with previous myocardial infarctions, congestive heart failure, and left ventricular hypertrophy. Our results confirm previous reports that an asymptomatic carotid stenosis is more often complicated by a TIA than an unheralded cerebral infarction. Cerebral infarctions that do occur are often only marginally related to the carotid bifurcation lesion. In patients with asymptomatic carotid bruit and stenosis, myocardial infarctions occur more frequently and are more commonly the cause of death than cerebral infarctions.