PREVALENCE AND OUTCOME OF SYMPTOMATIC CAROTID LESIONS IN YOUNG-ADULTS

Objective-To estimate the prevalence and outcome of symptomatic intern al carotid artery lesions in young adults. Design-Multicentre hospital based observational study with five year follow up. Setting-Seven neu rological departments in northern and central Italy. Subjects-240 pati ents (115 men) aged 15-44 with a recent transient ischaemic attack or stroke in the carotid territory. Main outcome measures-(a) Prevalence of symptomatic internal carotid artery stenosis or occlusion detected by continuous wave Doppler ultrasonography at entry; (b) incidence rat es of cerebral, cardiac, and non-vascular death; non-fatal stroke; and non-fatal myocardial infarction. Results-Carotid stenoses of 50-99% a nd occlusions were found in 38 patients (15.8%). Both conditions were significantly more frequent in patients aged over 35 and in those with hypertension, diabetes mellitus, and stroke at entry. The standardise d mortality ratio at five years was 10.5 (95% confidence interval 5.0 to 19.3). Survival of patients with stenoses of 0-49% and occlusions w as significantly better than that of patients with stenoses of 50-99%. Carotid stenosis of 50-99% was an independent predictor of death (haz ard ratio 7.9; 95% confidence interval 2.2 to 29) and non-fatal stroke (hazard ratio 7.4; 1.5 to 37.4). Conclusions-The prevalence of caroti d stenosis or occlusion in young adults after a cerebrovascular event is low. Though patients with high grade symptomatic carotid stenosis a re at risk of non-fatal and fatal events, patients with internal arter y occlusion apparently have a benign prognosis.