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Extracranial carotid arterial disease
1Hebrew Hospital Home, Bronx, NY 10475.
Comprehensive Therapy
|January 1, 1994
Summary
Elderly patients with significant carotid artery disease (ECAD) face higher risks of stroke and heart events. Managing risk factors like smoking and high cholesterol is crucial for better outcomes.
Area of Science:
- Vascular Surgery
- Cardiology
- Geriatrics
Background:
- Extracranial carotid artery disease (ECAD) is a significant cause of stroke.
- Noninvasive imaging like carotid duplex ultrasonography is key for ECAD evaluation.
- Carotid angiography is essential prior to endarterectomy.
Purpose of the Study:
- To identify prognostic variables for ECAD in the elderly.
- To analyze the relationship between ECAD severity and cerebrovascular events.
- To determine risk factors for new coronary events in ECAD patients.
Main Methods:
- Multivariate logistic regression analysis was employed.
- Patient data on ECAD severity, risk factors, and clinical outcomes were analyzed.
- Incidence of ABI, TIA, and new coronary events were compared across ECAD severity groups.
Main Results:
- Significant predictors for ECAD in the elderly include smoking, total cholesterol, HDL cholesterol, diabetes, and prior CAD.
- Higher degrees of ECAD (80-100% and 40-80%) correlate with increased incidence of ABI and TIA.
- ECAD patients exhibit higher prevalence of prior CAD and increased risk of new coronary events, influenced by silent ischemia, prior CAD, HDL, and smoking.
Conclusions:
- Risk factor modification (smoking cessation, managing hypertension, dyslipidemia, diabetes) is vital for ECAD patients.
- Aspirin (325 mg/d) is recommended; Ticlopidine is an alternative for specific cases.
- Carotid endarterectomy should be considered for symptomatic patients with 70-99% ECAD.