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Carotid arteries ultrasound screening in asymptomatic patients

Year: 2019, volume 15 Issue: №1 Pages: 190-199
Heading: Neurology Article type: Original article
Authors: Shchanitsyn I.N., Shvarts E.Yu., Ishmukhametova R.A., Vozdeeva A.S.
Organization: Saratov State Medical University
Summary:

Objective: to reveal the most important predictors of carotid artery stenosis in ambulatory patients of Saratov and Saratov Region with the help of multivariate analysis and to define an ideal patient for ultrasound screening. Material and Methods. In 2014-2018 off-site consultations and ultrasound screening were performed for asymptomatic patients with suspected carotid artery disease in outpatient clinics of Saratov and Saratov Region. Those patients were referred for screening by neurologists and general practitioners. The study used 470 medical charts. The multivariate regression analysis was performed to identify independent predictors of carotid artery stenosis (>50%). Results. The >30% carotid artery stenosis was detected in 24.5% (115/470) of participants, >50% stenosis — in 10.2% (48/470) of participants, >70% stenosis — in 2.9% (14/470) of participants. The multivariate analysis revealed that the odds of finding >50% stenosis in patients chosen by neurologists and general physicians for screening was significantly higher in the presence of following factors: age older then 72, male sex, acute cerebrovascular event more than 6 months ago, atherosclerosis in arteries of lower extremities, episodes of speech disorder. The point scale for risk assessment has been created. In the absence of prognostic factors the absolute risk of >50% stenosis was only 3%. In the presence of 1 point it was 16% and more than 50% in the presence of 4 points. Conclusion. The analysis we conducted allowed to specify major predictors of atherosclerosis in patients followed in outpatient clinics of Saratov and Saratov Region and to create the patient model which allows to optimize selection for ultrasound screening.

Keywords: asymptomatic stenosis, carotid stenosis

Bibliography:
1 Leonov SA, Golubev NA, Zaychenko NM. FRIHOI of MoH of the RF Statistic data on circulatory diseases. M., 2017; 295 p.
2 Pokrovsky AV, Abugov SA, Alekyan BG, et al. The National guidelines for the management of patients with diseases of brachiocephalic arteries. Angiology and Vascular Surgery 2013; (2): 1-70
3 Waard DD, Morris D, Borst GJ, et al. Asymptomatic carotid artery stenosis: who should be screened, who should be treated and how should we treat them? J Cardiovasc Surg (Torino) 2017; 58(1): 3-12
4 Jonas DE, Feltner C, Amick HR, et al. Screening for Asymptomatic Carotid Artery Stenosis: A Systematic Review and Meta-analysis for the US Preventive Services Task Force. Ann Intern Med 2014; 161 (5): 336-46
5 Gaba K, Ringleb PA, Halliday A. Asymptomatic Carotid Stenosis: Intervention or Best Medical Therapy? Curr Neurol Neurosci Rep 2018; 18 (11): 80
6 O'Brien M, Chandra A. Carotid revascularization: risks and benefits. Vase Health Risk Manag 2014; (10): 403-16
7 Le Fevre ML. Screening for asymptomatic carotid artery stenosis: US Preventive Services Task Force recommendation statement. Ann Intern Med 2014; 161 (5): 356-62
8 Russell EJ, Hetts SW, Bello JA, et al. ACR — ASNR — SIR — SNIS practice parameter for the performance of diagnostic cervicocerebral catheter angiography in adults. 2016 URL: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/Cer-vicoCerebralCathAngio.pdf (15 March, 2019)
9 Ahn SS, Baker JD, Walden K, Moore WS. Which asymptomatic patients should undergo routine screening carotid duplex scan? Am J Surg 1991; 162 (2): 180-3
10 Lawes CMM, Bennett DA, Feigin VL, RodgersA. Blood pressure and stroke: an overview of published reviews. Stroke 2004; 35 (3): 776-85
11 Rashid P, Leonardi-Bee J, Bath P. Blood pressure reduction and secondary prevention of stroke and other vascular events. Stroke 2003; 34 (11): 2741-8
12 JahromiAS, Cina CS, Liu Y, Clase CM. Sensitivity and specificity of color duplex ultrasound measurement in the estimation of internal carotid artery stenosis: A systematic review and meta-analysis. J Vase Surg 2005; 41 (6): 962-72
13 Aizenberg DJ. Cardiovascular testing in asymptomatic patients. Med Clin North Am 2016; 100 (5): 971-9
14 European carotid surgery trialists' collaborative group. MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis European Carotid Surgery Trialists' Collaborative Group. Lancet (London, England) 1991; 337 (8752): 1235-43
15 Goldstein LB, Bushnell CD, Adams RJ, et al. Guidelines for the primary prevention of stroke. Stroke 2011; 42 (2): 517-84
16 Brott TG, Halperin JL, Abbara S, et al. 2011 ASA/ ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/ SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary. J Neurointerv Surg 2011; 3 (2): 100-30
17 Ricotta JJ, Abu Rahma A, Ascher E, et al. Updated Society for Vascular Surgery guidelines for management of extra-cranial carotid disease. J Vase Surg 2011; 54 (3): 1-31
18 Mayberg MR, Winn HR. Endarterectomy for asymptomatic carotid artery stenosis Resolving the controversy. JAMA 1995; 273 (18): 1459-61
19 Hobson RW, Weiss DG, Fields WS, et al. Efficacy of carotid endarterectomy for asymptomatic carotid stenosis. The Veterans Affairs Cooperative Study Group. N Engl J Med 1993; 328 (4): 221-7
20 Halliday AL, Mansfield A, Marro J, et al. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet 2004; 363 (9420): 1491-502
21 Howard VJ, Meschia JF, Lai BK, et al. Carotid revas-cularization and medical management for asymptomatic carotid stenosis: Protocol of the CREST-2 clinical trials. Int J Stroke 2017; 12 (7): 770-8
22 Eckstein HH, Reiff T, Ringleb P, et al. SPACE-2: A missed opportunity to compare carotid endarterectomy, carotid stenting, and best medical treatment in patients with asymptomatic carotid stenoses. Eur J Vase Endovasc Surg 2016; 51 (6): 761-5
23 Munster AB, Franchini AJ, Qureshi Ml, et al. Temporal trends in safety of carotid endarterectomy in asymptomatic patients: systematic review. Neurology 2015; 85 (4): 365-72
24 Naylor AR. Time to rethink management strategies in asymptomatic carotid artery disease. Nat Rev Cardiol 2011; 9 (2): 116-24
25 Drozdova LYu, Martsevich SYu, Voronina VP Evaluation of cardiovascular risk factors prevalence and efficacy of their correction in physicians. Estimation of physicians' expertise in up-to-date clinical guidelines. Rational Pharmacother Card 2011; 7 (2): 137-44
26 Martsevich SI, Kutishenko NP, Drozdova LY, et al. Ursodeoxycholic acid-enhanced efficiency and safety of statin therapy in patients with liver, gallbladder, and/or biliary tract diseases: The RACURS study. Ter Arkh 2014; 86 (12): 48-52
27 Shalnova SA, Balanova YuA, Konstantinov VV, et al. Arterial hypertension: prevalence, awareness, antihypertensive pharmaceutical treatment, treatment effectiveness in Russian population. Russian Journal of Cardiology 2006; (4): 45-50
28 Pujia A, Rubba Р, Spencer МР Prevalence of extra-cranial carotid artery disease detectable by echo-Doppler in an elderly population. Stroke 1992; 23 (6): 818-22
29 Holloway RG, Benesch CG, Rahilly CR, Courtright CE. Asystematic review of cost-effectiveness research of stroke evaluation and treatment. Stroke 1999; 30 (7): 1340-9
30 Yin D, Carpenter JP Cost-effectiveness of screening for asymptomatic carotid stenosis. J Vase Surg 1998; 27

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