Prevalence of extracranial carotid artery disease detectable by echo-Doppler in an elderly population.

Abstract

Background and Purpose: Little information is available on extracranial carotid artery disease in free-living elderly individuals. We sought to evaluate the prevalence of carotid lesions in the elderly.Methods: Using echo-Doppler, we assessed the prevalence of possible atherosclerotic lesions in the internal carotid arteries (n=478) and the external and common carotid arteries (n=956) of 239 subjects 65-94 years of age living in retirement homes in Seattle, Wash.Results: We found that 152 (31.8%) internal carotid arteries were affected by nonstenosing plaque and 37 arteries (7.7%) had stenosis or occlusion. In addition, 193 (202%) external or common carotid arteries showed nonstenosing plaques. There were 128 subjects (53.6%) with internal carotid disease, 106 (443%) with evidence of external or common carotid disease, and 75 (31.4%) affected by disease in all three sites. There were 80 subjects (33.5%) with no ultrasound evidence of carotid disease. We found that the presence and severity of carotid disease increased between the decades 65-74 and 75-84. We also demonstrated a positive association between systolic blood pressure and ultrasound evidence of carotid disease that was independent of age.Conclusions: The prevalence of extracranial artery disease in an apparently healthy population was high, although stenoses in most instances were not severe. We conclude that noninvasive ultrasound methods identify a relatively small fraction of individuals (5% of the total) at high risk for stroke or transient ischemic attack. Echo-Doppler might be used to monitor further disease progression and to evaluate the efficacy of different therapeutic or preventive interventions. (Stroke 1992^3:818-822) KEY WORDS • aged • arteriosclerosis • carotid artery diseases • ultrasonics

Carotid plaque, aging, and risk factors. A study of 457 subjects.

“…However, Jungquist et al 14 did not find any statistically significant relation between risk factors and the extent of carotid atherosclerosis in subjects aged 69 years. Pujia et al, 28 in their study on elderly patients living in retirement homes, did not find any statistically significant relation between cardiovascular risk factors and the presence of carotid lesions. Although hypertension, cigarette smoking, and diabetes mellitus are considered important risk factors for atherosclerosis, we failed to confirm this relation in elderly patients.…”

“…O'Leary et al, 13 in their survey of 5201 subjects aged 65 or older, observed, as we did, that maximum stenosis increased with age, but the prevalence of severe stenosis (75% to 100%) was quite low in both men (2.3%) and women (1.1%). Pujia et al 28 reported a prevalence of 5% of flow-reducing stenosis (lumen reduction >50%) in subjects aged 75 or older. Jungquist et al 14 found stenosis of 60% or greater in 4.5% of men aged 69 examined in his study.…”

Realizing the Potential of Carotid Artery Stenting

“…6 Thus, for clinical benefit to be derived by an asymptomatic patient with a severely stenotic carotid lesion, periprocedural rates of death or stroke after carotid revascularization must not exceed 3%. 5 Given the high prevalence of asymptomatic carotid disease, 46,47 the optimal application of carotid stenting in this patient subset must be defined rigorously (see "The 3% Rule" below). †Lesion severity is determined according to the NASCET methodology (ie, the ratio between lumen diameter at the point of maximal stenosis and the lumen diameter of the nontapered segment of the distal ICA).…”

Atherosclerotic Carotid Stenoses of Apical versus Body Lesions in High-Risk Carotid Stenting Patients

“…1 Vessel segments with low WSS and resultant flow stagnation at the carotid bulb appear to be at highest risk for development of atherosclerosis. 2 Together with the condition of low WSS, a large lipid pool contributes to development of vulnerable plaque.…”