CAROTID-ARTERY STENOSIS IN PERIPHERAL VASCULAR-DISEASE

Purpose: The goal of the study was to assess the prevalence and severi ty of symptomatic and asymptomatic carotid artery disease in patients with peripheral vascular disease (PVD). Methods: Consecutive patients with clinically and Doppler scanning-proven PVD (category 1 or greater ) underwent prospective screening for the presence of carotid atherosc lerosis with color-coded duplex ultrasonography. Preexisting risk fact ors were recorded with a standard questionnaire and included sex, age, diabetes mellitus, history of smoking, hypertension, prior stroke/tra nsient ischemic attacks, and coronary artery disease. Results: Three h undred seventy-three consecutive patients were studied over 2 years. T he mean age of the patients was 70 +/- 10 years; there were 223 (60%) men and 150 (40%) women; 71% of the patients had a history of smoking, 47% had coronary artery disease, 43% had hypertension, and 21% had di abetes mellitus. Two hundred eleven (57%) patients had 30% or greater carotid artery stenosis detected by carotid artery duplex scanning. Si xty-seven (32%) of these had symptoms of ischemic cerebral events, of whom 22 had potentially operable carotid artery stenoses (70% to 99%), whereas 72 of the 144 symptom-free patients had 60% to 99% stenosis. An additional 34 patients would be eligible candidates for the ongoing carotid endarterectomy trials (North American Symptomatic Carotid End arterectomy Trial and European Carotid Surgery Trial). Although all th e risk factors were associated significantly with PVD and carotid arte ry disease (p < 0.002), male sex and prior stroke/transient ischemic a ttack were the strongest predictors. Conclusions: Routine carotid ultr asound screening of 373 consecutive patients with category I or greate r PVD revealed that 22 patients with symptoms and 72 symptom-free pati ents were potential surgical candidates, representing 25% of the study cohort. An additional 34 patients were potential candidates for enrol lment into the North American Symptomatic Carotid Endarterectomy Trial and European Carotid Surgery Trial.