Francesco A. Aiello, Andrew J. Meltzer, Brian Cohen, Melinda Espiritu, Jason Burmeister, Rahima Hoque, James F. McKinsey, Gautum Shrikhande
Vascular Surgery, New York Presbyterian Hospital, New York, NY.
OBJECTIVES: Determine the degree of carotid artery stenosis and factors affecting progression of carotid disease in patients with peripheral arterial disease (PAD).
METHODS: A retrospective analysis of consecutive patients undergoing peripheral vascular studies and carotid duplex ultrasound (DUS) was performed. Incidence of stenosis and disease progression were assessed. Clinical presentation, comorbidities, and aspirin, clopidogrel or statin use were analyzed using univariate and multivariate analysis. Patients with previous carotid intervention or neurologic event were excluded.
RESULTS: Between 2004 and 2010, 1074 carotid arteries in 542 patients underwent DUS with a mean follow-up of 32 (12-84) months for those with repeat DUS. Average age was 72±10 years and 54.2% were male. Initial DUS revealed 20.1% of carotid arteries had stenosis ≥50% and 1.4% were occluded. Univariate analysis showed ethnicity, smoking, ABI ≤0.5 and ABI 0.51-0.80 were significant factors (p<0.05). ABI≤0.8 and smoking remained significant after multivariate analysis. ABI ≤0.5 had a 26% incidence of carotid artery stenosis (CAS) ≥50% while an ABI 0.51-0.80 had a 24.8% incidence. Aspirin, clopidogrel and statin use at initial DUS was not statistically significant in predicting CAS. Surveillance DUS revealed progression in 11.4% of all carotid arteries. Overall, 23 (2.1%) carotid arteries progressed to clinically relevant disease including transient ischemic attacks (5), stroke (5), ≥80% stenosis (10), or occlusion (3). Univariate analysis revealed hypertension, coronary artery disease, myocardial infarction, smoking and ABI≤0.8 as significantly affecting disease progression (p<0.05). Multivariate analysis revealed CAD and smoking as independent risk factors for disease progression.
CONCLUSIONS: Screening carotid artery DUS is warranted in patients diagnosed with PAD and ABI ≤0.8 or smoking history. Patients with CAD and a history of smoking should undergo surveillance carotid DUS due to significantly higher incidence of disease progression.
AUTHOR DISCLOSURES: F. A. Aiello, Nothing to disclose; J. Burmeister, Nothing to disclose; B. Cohen, Nothing to disclose; M. Espiritu, Nothing to disclose; R. Hoque, Nothing to disclose; J. F. McKinsey, Nothing to disclose; A. J. Meltzer, Nothing to disclose; G. Shrikhande, Nothing to disclose.
Posted April 2012