Abstract
Introduction: carotid atherosclerotic disease (CAD) is cause of about 15% of acute strokes. Its prevalence could be high in the Latin American population, but this information, in general, is largely unknown.
Objetive: to describe the prevalence, severity and risk factors of CAD in a Mexican population from a third-level referral center.
Materials and Methods: a total of 545 clinical records of patients who received carotid ultrasound in a period of 23 months were reviewed. We analyzed the prevalence and severity of CAD, and compared risk factors between patients with and without this condition.
Results: the general prevalence of CAD was 54.7% (95% confidence interval: 50.5% to 58.8%): mild 48% and moderate-severe 7%. The most frequent risk factors were hypertension (64.8%, moderate-severe CAD: 86.8%), hypercholesterolemia (47.5%, moderate-severe CAD: 60.5%) and diabetes mellitus (40%, moderate-severe CAD: 44.7%). Twenty nine percent of patients had history of cerebral infarction. Most patients received statins and/or fibrates (68.3%, moderate-severe CAD: 86.8%), antiplatelets (62%, moderate-severe CAD: 86.8%) and angiotensin-converting enzyme inhibitors (42.8%, moderate-severe CAD: 71.1%). Among the 38 patients with moderate-severe CAD, 13 (34.2%) received carotid revascularization (12 endarterectomy and 1 angioplasty plus stenting).
Conclusion: the prevalence of CAD in this Mexican population is similar to that reported in other countries. Most patients are treated conservatively. Emphasis should be made on optimal control of cardiovascular risk factors associated with CAD.
References
CANTÚ-BRITO C. Atherosclerotic carotid stenosis. How to decide endarterectomy versus stenting versus only medical treatment?. Rev Invest Clin. 2009;61:53-65.
CANTÚ-BRITO C, RUIZ-SANDOVAL JL, ARAUZ-GÓNGORA A, VILLARREAL-CAREAGA J, BARINAGARREMENTERÍA F, MURILLO-BONILLA LM, ET ÁL. Prevalencia de estenosis carotídea en pacientes con isquemia cerebral transitoria en México. Rev Mex Neuroc. 2010;11:343-8.
FISHER M. Occlusion of the internal carotid artery. AMA Arch Neurol Psychiatry. 1951;65:346-77.
ESTOL CJ. Miller Fisher and the history of carotidartery disease. Stroke. 1996;27:559-66.
FIELDS WS. The history of carotid endarterectomy. Rev Neurol Argent. 1991;16:20-8.
PADILLA-MARTÍNEZ JJ, GUTIÉRREZ-PADILLA JG, VILLAGÓMEZ-MÉNDEZ JA, ÁLVAREZ-PALA-ZUELOS LE, CHIQUETE E, GÓMEZ-ANGULO HL, ET ÁL. Manifestaciones oftalmológicas de la enfermedad carotídea aterosclerosa. Rev Mex Neuroci. 2007;8:82-5.
U-KING-IM JM, YOUNG V, GILLARD JH. Carotid-artery imaging in the diagnosis and management of patients at risk of stroke. Lancet Neurol. 2009;8:569-80.
BAQUIS GD, PESSIN MS, SCOTT MR. Limb shaking-a carotid TIA. Stroke. 1985;16:444-8.
ESCOBEDO J, SCHARGRODSKY H, CHAMPAGNE B, SILVA H, BOISSONNET CP, VINUEZA R, ET ÁL. Prevalence of the metabolic syndrome in Latin America and its association with sub-clinical carotid atherosclerosis: the CARMELA cross sectional study. Cardiovasc Diabetol. 2009;8:52.
GONZÁLEZ-VILLALPANDO C, STERN MP, RIVERA MARTÍNEZ D, ARREDONDO PÉREZ B, MARTÍNEZ DIAZ S, HAFFNER S. Carotid artery atherosclerosis in a Mexico City population with high carbohydrate intake. Arch Med Res. 1995;26:409-13.
WEI M, GONZALEZ C, HAFFNER SM, O'LEARY DH, STERN MP. Ultrasonographically assessed maximum carotid artery wall thickness in Mexico City residents and Mexican Americans living in San Antonio, Texas. Association with diabetes and cardiovascular risk factors. Arterioscler Thromb Vasc Biol. 1996;16:1388-92.
RODRÍGUEZ SALDAÑA J, CANTÚ BRITO C, SOSA ESPINOSA P, REYNOSO MARENCO MT, ZUCKERMANN FOULLÓN D, BARINAGAR-REMENTERÍA ALDATZ F. Prevalence of carotid atherosclerosis in a cohort of Mexico City. Arch Inst CardiolMex. 1998;68:44-50.
ELIASZIW M, RANKIN RN, FOX AJ. Accuracy and prognostic consequences of ultrasonography in identifying severe carotid artery stenosis. North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group. Stroke. 1995;26:1747-52.
GRANT EG, BENSON CB, MONETA GL, ALEXANDROV AV, BAKER JD, BLUTH EI, ET-ÁL. Carotid artery stenosis: gray-scale and Doppler US diagnosis-Society of Radiologists in Ultrasound Consensus Conference. Radiology 2003;229:340-6.
HUSTON J 3RD, JAMES EM, BROWN RD JR, LEFSRUD RD, ILSTRUP DM, ROBERTSON EF, MEYER FB, HALLETT JW. Redefined duplex ultrasonographic criteria for diagnosis of carotid artery stenosis. Mayo Clin Proc. 2000;75:1133-40.
North American Symptomatic Carotid Endar-terectomy Trial Collaborators. Beneficial effect of endarterectomy in carotid symptomatic patients with high grade carotid stenosis. N Engl J Med. 1991;325:445-53.
BARNETT HJ, TAYLOR DW, ELIASZIW M, FOX AJ, FERGUSON GG, HAYNES RB, ET-AL. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 1998;339:1415-1425.
European Carotid Surgery Triallists' Collaborative Group. Randomised Trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial. Lancet. 1998;351:1379-87.
European Carotid Surgery Triallists'. MRC Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or mild (0-29%) carotid stenosis. Lancet. 1991;337:1235-13.
GURM HS, YADAV JS, FAYAD P, KATZEN BT, MISHKEL GJ, BAJWA TK, ANSEL G, STRICKMAN NE, WANG H, COHEN SA, MASSARO JM, CUTLIP DE; SAPPHIRE INVESTIGATORS. Long-term results of carotid stenting versus endarterectomy in high-risk patients. NEngl J Med. 2008;58:1572-79.
HOBSON RW. 2nd. Update on the Carotid Revascularization Endarterectomy versus Stent Trial (CREST) protocol. J Am Coll Surg. 2002;194:S9-S14.
BROTT TG, HOBSON RW, HOWARD G, ROUBIN GS, CLARK WM, BROOKS W, ET AL. Stenting versus endarterectomy for treatment of carotid-artery stenosis. NEngl J Med. 2010;363:11-23.
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