Color carotid ultrasonography findings helps pinpoint stroke risk


By David Douglas

NEW YORK (Reuters Health) – In patients with carotid stenosis, the ultrasonic characteristics of plaque can help define the risk of future stroke, according to a study by Greek researchers.

In fact, lead author Dr. Christos D. Liapis told Reuters Health that "color ultrasound examination on carotids suggests that besides the traditional risk factors for stroke–for example, hypertension, smoking, and high cholesterol–a marker of an imminent stroke is also the presence in the carotids of an echolucent or 'black' plaque."

Dr. Liapis and colleagues, at Laiko Hospital in Athens, conducted an open prospective study to identify factors affecting symptomatology in patients with carotid stenosis. The findings appear in the December issue of Stroke: Journal of the American Heart Association.

Over a ten-year period, the researchers performed color Duplex ultrasonography on 442 arteries with various degrees of stenosis. Sonography was performed every 6 months, patients were observed for a mean of 44 months, and each had a mean of about 7 scans.

Men, patients with hypertension, and those with echolucent plaques showed a trend towards a higher frequency of stroke in their history. Significant stenosis progression was seen in 18.5% of patients. This occurs significantly more often in younger patients, as well as in those with coronary artery disease and echolucent plaques.

Overall, there was a 12.4% incidence of neurological events, and these were significantly associated with having had a history of such events, the severity of carotid disease, progression of stenosis, hypertension, and echolucent plaques.

In light of these results, Dr. Liapis added that it is "imperative to scan regularly with ultrasound the carotids of middle age or older males and if such plaques are found, to start an aggressive therapy of lipid lowering, hypertension control, cessation of smoking, antiplatelet agents and, depending on the degree of stenosis, surgery."

Furthermore, he suggested that "this finding of a very accurate predictor of future stroke and other cardiovascular events can change the current thinking about the need for closer follow-up of people that may have currently no symptoms, but might eventually suffer from a catastrophic stroke."

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