Progression of Mild to Moderate Stenosis in the Internal Carotid Arteries of Patients With Ischemic Stroke

Abstract

Background and purpose: Severe stenosis in the internal carotid artery may increase the risk of ischemic stroke. The factors that affect the progression of carotid artery stenosis in patients with ischemic stroke are poorly studied. No guidelines for the duration of follow-up of patients with ischemic stroke through carotid ultrasonography exist.Methods: In this retrospective study, 179 patients (108 men; mean age, 68 years) with ischemic stroke and mild to moderate stenosis in the internal carotid artery (ICA) were recruited. Carotid artery ultrasonography was performed over the period of January 2013 to June 2016 with a median follow-up of 36 months (mean 36.5 ± 3.5 months). The severity of carotid artery stenosis was estimated with the following equation: 1– (narrowest ICA diameter/total lumen diameter at the narrowest site). The severity of stenosis was categorized into grades I (0–29%), II (30–49%), III (50–59%), and IV (60–69%). The patient's stenosis grade was defined on the basis of the stenosis rate of the ICA side with most severe stenosis.Results: Stenosis progressed in 17.9% (64/358) of the vessels in 30.7% (55/179) of patients. The risk of stenosis progression increased as the severity of ICA stenosis increased. Patients with stenosis rates of above 50% are at a higher risk of stenosis progression than those with stenosis rate of < 50%. Relative to the patient group with an ICA stenosis rate of 0–29%, the adjusted odds ratios of stenosis progression were 2.33 (p = 0.03; 95% CI: 1.05~5.17), 3.50 (p = 0.09; 95% CI: 0.81~15.84), and 6.61 (p = 0.03; 95% CI: 1.01~39.61) in patient groups with ICA stenosis rates of 30–49%, 50–59%, and 60–69%, respectively. Hyper-LDL-cholesterolemia (Hyper-LDL-c) also increased the risk of stenosis progression, with an adjusted odds ratio of 2.22 (p = 0.03; 95% CI: 1.05~4.71).Conclusion: The rate of ICA stenosis progression increases with stenosis grade. Patients with ICA stenosis severity >50% and Hyper-LDL-c have high rates of stenosis progression. For the patients with stroke and ICA stenosis severity >50%, annual follow up through carotid artery ultrasonography may be necessary.

Association Between Low-Density Lipoprotein Cholesterol (LDL-C) Level and Unfavorable Outcomes in Participants of Ischemic Stroke without Diabetes: A Multi-Center Retrospective Study

“…Epidemiological studies found that LDL-C was significantly related to the pathogenesis of cerebral infarction, and several studies confirmed that serum LDL-C level was one of the independent risk factors for ischemic stroke [9]. Moreover, previous studies showed that LDL-C level was positively correlated with carotid stenosis in elderly patients with cerebral infarction, and also positively correlated with the severity of cerebral infarction [12]. This discrepancy could also be explained by differences in study design.…”

Prevalencia de enfermedad carotídea posterior a accidente cerebrovascular en un hospital universitario de Bogotá (Colombia)

“…Las características del estudio se muestran en la tabla 3. Al comparar los datos, la edad media de 78 años fue similar a la previa de 81 años (19), pero ambas son mayores a las descritas en otros trabajos de 66 a 72 años (11,15,20,21,22). Existen asociaciones bien estudiadas con mayor significancia para estenosis carotídea, como son la edad, sobre todo en mayores de 70 años (OR = 4,68); género masculino (OR = 2,16); aumento de las LDL (OR = 1,84); HTA (OR = 3,16), y tabaquismo (OR = 6,18) (18, 22,23,24,25).…”

“…También se han asociado la diabetes mellitus tipo 2 y la enfermedad coronaria como condicionante de enfermedad carotídea severa (14, 19,22). En estas dos mediciones, en diferentes periodos (1996-2002 vs. 2014-2018), los factores de riesgo se encuentran presentes y en proporciones muy similares; sin embargo, hay mayor proporción de HTA y de dislipidemia para los datos actuales, con menor proporción de enfermedad coronaria, diabetes y tabaquismo respecto a otras poblaciones como la del estudio Nascet (9,26,27).…”

Low Levels of IgM Recognizing 4-Hydroxy-2-Nonenal-Modified Apolipoprotein A-I Peptide and Its Association with the Severity of Coronary Artery Disease in Taiwanese Patients

“…Exclusion criteria included (1) subjects with mental disorders or disturbances of consciousness and those who could not understand the statements of the research team, (2) patients with acute coronary syndrome, (3) patients with a history of abnormal blood coagulation, and (4) patients who were unwilling to participate in this study. Coronary artery stenosis was calculated using the following equation: (1 − (the diameter of diseased vessel/the diameter of reference)) × 100% according to the result of quantitative coronary angiography [ 29 ]. Depending on the severity of coronary artery stenosis, CAD sufferers were divided into three groups: <30%; 30%~70%; and >70%.…”