A 79-Year-Old Musician With Asymptomatic Carotid Artery Disease

Caplan, Louis R.

doi:10.1001/jama.1995.03530170063034

Cited by 6 publications

(4 citation statements)

References 55 publications

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“…27 Also, in a recent "Clinical Crossroads," auscultation of a carotid bruit in an asymptomatic 79-year-old man was the cue to obtain an ultrasound examination in search of carotid stenosis. 28 Our data show that carotid bruits in asymptomatic elderly with isolated systolic hypertension-even those with multiple other risk factors-do not identify persons at increased risk of subsequent stroke. Although we cannot rule out a small increased risk of stroke associated with bruits in asymptomatic SHEP enrollees aged 60 to 69 years, the utility of carotid bruits as a marker for increased stroke risk among asymptomatic elderly with isolated systolic hypertension aged 70 years or older is limited.…”

Section: Discussionmentioning

confidence: 60%

The prognostic significance of asymptomatic carotid bruits in the elderly

et al. 1998

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OBJECTIVE:To determine the association between asymptomatic carotid bruits and the development of subsequent stroke in older adults with isolated systolic hypertension. DESIGN:Retrospective cohort study. SETTING:The Systolic Hypertension in the Elderly Program (SHEP), a 5-year randomized trial testing the efficacy of treating systolic hypertension in noninstitutionalized persons aged 60 years or older. From the original 4,736 SHEP participants, we identified a cohort of 4,442 persons who had no prior history of stroke, transient ischemic attack, or myocardial infarction at randomization. MEASUREMENTS AND MAIN RESULTS:The end point for this ancillary study was the development of a stroke. S troke is an important cause of morbidity, mortality, loss of independence, and institutionalization. Age is a major risk factor for stroke, with rates doubling in each decade after 55 independent of other known risk factors. 1 Hypertension, cigarette smoking, diabetes, and atrial fibrillation are also major risk factors for stroke. 2 Although the development of symptomatic carotid disease (e.g., transient ischemic attacks [TIAs]) identifies persons at high risk of subsequent strokes, most strokes occur without previous symptoms. 3 Thus, the identification and management of asymptomatic elderly at high risk of subsequent stroke is an important public health issue. In asymptomatic persons with atrial fibrillation, the utilization of oral anticoagulants reduces the risk of stroke. 4 However, the prevention of stroke for asymptomatic persons without atrial fibrillation depends largely on reducing known risk factors and, in appropriate candidates, identifying persons with surgically remediable high-grade carotid artery stenosis. [2][3][4] Auscultation for carotid bruits is noninvasive and inexpensive, but its utility in detecting asymptomatic older adults at increased risk of stroke has been incompletely studied. 5 Early studies found an increased risk of carotid bruits among persons suffering stroke compared with control subjects 6,7 ; however, these studies were nonblinded and potentially subject to observer bias. Population-based prospective studies found that persons with carotid bruits were at higher risk of subsequent stroke, 8-10 but age-specific risks were not reported. In contrast, a study of nursing home residents aged 75 years or older found no increased risk of stroke among persons with asymptomatic carotid bruits. However, sample size was small, and the generalizability of this finding to less frail elderly is not known. 11 Given the age-related prevalence of carotid bruits, and the paucity of data on the utility of neck auscultation to predict stroke in older adults, we conducted a retrospective cohort study of Systolic Hypertension in the Elderly Program (SHEP) participants to determine the risk of stroke associated with asymptomatic carotid bruits.

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Section: Discussionmentioning

confidence: 60%

The prognostic significance of asymptomatic carotid bruits in the elderly

et al. 1998

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“…DR CAPLAN: I participated in a Clinical Crossroads 12 years ago concerning management of asymptomatic carotid artery disease. 71 Since then, more information is available about prognosis. The risk of stroke in patients with asymptomatic carotid stenosis is about 2% to 2.5% a year.…”

Section: Questions and Discussionmentioning

confidence: 99%

A 70-Year-Old Man With a Transient Ischemic Attack

Caplan¹

2008

JAMA

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“…76 I do not think surgery or interventional repair of the ICA in asymptomatic patients should be seriously considered unless the stenosis is severe (Ͼ80% luminal narrowing). 76 I do not think surgery or interventional repair of the ICA in asymptomatic patients should be seriously considered unless the stenosis is severe (Ͼ80% luminal narrowing).…”

Section: Asymptomatic Patients With Internal Carotid Artery Disease Imentioning

confidence: 99%

“…78 A European study also reported a benefi t for surgery, but women and those over 65 years of age did not fare as well as men and younger individuals. 76 Data are now accruing about the results of angioplasty/stenting in patients with asymptomatic ICA atherosclerotic disease. [80][81][82] Many neurologists and vascular surgeons question the need for catheter angiography in these patients and rely on duplex ultrasound and vascular imaging with MRA or CTA.…”

Section: Asymptomatic Patients With Internal Carotid Artery Disease Imentioning

confidence: 99%