Extent and progression of atherosclerosis in carotid and subclavian arteries: the Carotid Artery Subclavian Artery study

Abstract

Aims To define the prevalence, progression, and the relationship between carotid and subclavian artery atherosclerosis and to identify factors associated with disease progression in a population of asymptomatic patients. Methods Among all consecutive patients without a history of cardiovascular disease admitted to our hospital for duplex ultrasound examinations of the supra-aortic arteries, from January to December 2012, we retrospectively identified 530 patients with two evaluations at least 3 years apart. Each artery was graded according to stenosis degree, as absent or less than 20%, 20–49%, 50–69%, 70–99% and total occlusion. Disease progression was defined for any class increase at any time interval. Patients were grouped according to the presence of a more than 20% stenosis of the supra-aortic district at baseline, as controls, without atherosclerosis: n = 111, 21%; isolated carotid artery disease: n = 390, 74%; concomitant subclavian artery-carotid artery disease: n = 29, 5%. There were no cases with isolated subclavian artery atherosclerosis. Results The mean time-lapse between the two evaluations was 3.1 ± 0.3 years; we documented disease progression in 32 patients (6%), all limited to the carotid artery (P = 0.009 vs. controls, with no differences between isolated carotid artery disease and concomitant carotid and subclavian artery disease). Hypertension was significantly (P < 0.001) associated with disease progression, regardless of the single or double district involvement. Conclusion The subclavian artery is far less prone to atherosclerosis than the carotid artery, and features lesser disease progression. Understanding factors for the different susceptibility to atherosclerosis in these two close arterial districts provides insight into local factors prompting vascular disease.

Variability of Measurement and Feasibility of Assessing Changes in Brachiocepahlic Atherosclerotic Plaque After Acute Coronary Syndrome

“…Исследование правой подключичной артерии, в большинстве случаев не входящее в стандартный протокол количественного УЗИ анализа БЦА, было признано целесообразным с учетом данных I. Pescetelli и соавт. [6] об обнаружении бляшки данной локализации даже в отсутствие каротидного и коронарного атеросклероза у пациентов с низким риском развития ССЗ в отсутствие симптомов. Критерием наличия атеросклероза служит визуализация АСБ, определяемой, согласно Манхеймскому соглашению, как фокальное образование, создающее выпячивание в просвет сосуда более чем на 0,5 мм или на 50 % в сравнении с толщиной интимы-медии рядом, или локальное утолщение стенки более 1,5 мм при измерении от границы просвет-интима до границы медиа-адвентиция [7].…”