Advertisement

Carotid Artery Stenosis Prevalence and Medical Therapy

  • Rohit Khurana
  • Philip Teal
Chapter
Part of the Contemporary Cardiology book series (CONCARD)

Abstract

Stroke is a leading cause of disability and mortality worldwide, with the burden projected to increase. A substantial proportion of ischemic stroke syndromes are secondary to occlusive carotid disease. Established cerebrovascular disease is a marker of disease in other vascular territories and predicts future global atherothrombotic events. A number of landmark trials have established an evidence base supporting medical intervention strategies to prevent recurrent vascular events. In addition to lifestyle modification, antiplatelet therapy, statins, and anti-hypertensive agents should be routinely administered to stroke patients.

Keywords

Carotid bruit Carotid stenosis Stroke Cerebrovascular disease Stroke syndrome Secondary prevention Antiplatelet therapy Statin ACE inhibitor 

References

  1. 1.
    White H, Boden-Albala B, Wang C, et al. Ischemic stroke subtype incidence among whites, blacks, and Hispanics: the Northern Manhattan Study. Circulation 2005;111:1327–1331.PubMedCrossRefGoogle Scholar
  2. 2.
    Rother J, Alberts MJ, Touze E, et al. Risk factor profile and management of cerebrovascular patients in the REACH Registry. Cerebrovasc Dis 2008;25:366–374.PubMedCrossRefGoogle Scholar
  3. 3.
    Bhatt DL, Fox KA, Hacke W, et al. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med 2006;354:1706–1717.PubMedCrossRefGoogle Scholar
  4. 4.
    Byington RP, Furberg CD, Crouse JR, 3rd, Espeland MA, Bond MG, Pravastatin, Lipids, and Atherosclerosis in the Carotid Arteries (PLAC-II). Am J Cardiol 1995;76:54C–59C.PubMedCrossRefGoogle Scholar
  5. 5.
    Bittl JA, Hirsch AT, Concomitant peripheral arterial disease and coronary artery disease: therapeutic opportunities. Circulation 2004;109:3136–3144.PubMedCrossRefGoogle Scholar
  6. 6.
    Inzitari D, Eliasziw M, Gates P, et al. The causes and risk of stroke in patients with asymptomatic internal-carotid-artery stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 2000;342:1693–1700.PubMedCrossRefGoogle Scholar
  7. 7.
    MacMahon S, Sharpe N, Gamble G, et al. Effects of lowering average of below-average cholesterol levels on the progression of carotid atherosclerosis: results of the LIPID Atherosclerosis Substudy. LIPID Trial Research Group. Circulation 1998;97:1784–1790.Google Scholar
  8. 8.
    Norris JW, Zhu CZ, Bornstein NM, Chambers BR, Vascular risks of asymptomatic carotid stenosis. Stroke 1991;22:1485–1490.PubMedCrossRefGoogle Scholar
  9. 9.
    Moore WS, Barnett HJ, Beebe HG, et al. Guidelines for carotid endarterectomy. A multidisciplinary consensus statement from the Ad Hoc Committee, American Heart Association. Circulation 1995;91:566–579.PubMedCrossRefGoogle Scholar
  10. 10.
    Chambers BR, Norris JW, Outcome in patients with asymptomatic neck bruits. N Engl J Med 1986;315:860–865.PubMedCrossRefGoogle Scholar
  11. 11.
    Wolff T, Guirguis-Blake J, Miller T, Gillespie M, Harris R, Screening for carotid artery stenosis: an update of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2007;147:860–870.PubMedCrossRefGoogle Scholar
  12. 12.
    Heyman A, Wilkinson WE, Heyden S, et al. Risk of stroke in asymptomatic persons with cervical arterial bruits: a population study in Evans County, Georgia. N Engl J Med 1980;302:838–841.PubMedCrossRefGoogle Scholar
  13. 13.
    Rothwell PM, Eliasziw M, Gutnikov SA, et al. Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet 2003;361:107–116.PubMedCrossRefGoogle Scholar
  14. 14.
    Pickett CA, Jackson JL, Hemann BA, Atwood JE, Carotid bruits as a prognostic indicator of cardiovascular death and myocardial infarction: a meta-analysis. Lancet 2008;371:1587–1594.PubMedCrossRefGoogle Scholar
  15. 15.
    Davis BR, Vogt T, Frost PH, et al. Risk factors for stroke and type of stroke in persons with isolated systolic hypertension. Systolic Hypertension in the Elderly Program Cooperative Research Group. Stroke 1998;29:1333–1340.PubMedCrossRefGoogle Scholar
  16. 16.
    Folsom AR, Rosamond WD, Shahar E, et al. Prospective study of markers of hemostatic function with risk of ischemic stroke. The Atherosclerosis Risk in Communities (ARIC) Study Investigators. Circulation 1999;100:736–742.PubMedCrossRefGoogle Scholar
  17. 17.
    Lawes CM, Bennett DA, Feigin VL, Rodgers A, Blood pressure and stroke: an overview of published reviews. Stroke 2004;35:1024.PubMedCrossRefGoogle Scholar
  18. 18.
    Amarenco P, Labreuche J, Lavallee P, Touboul PJ, Statins in stroke prevention and carotid atherosclerosis: systematic review and up-to-date meta-analysis. Stroke 2004;35:2902–2909.PubMedCrossRefGoogle Scholar
  19. 19.
    Final report on the aspirin component of the ongoing Physicians' Health Study. Steering Committee of the Physicians' Health Study Research Group. N Engl J Med 1989;321:129–135.CrossRefGoogle Scholar
  20. 20.
    Ridker PM, Cook NR, Lee IM, et al. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. N Engl J Med 2005;352:1293–1304.PubMedCrossRefGoogle Scholar
  21. 21.
    Corti R, Fuster V, Fayad ZA, et al. Lipid lowering by simvastatin induces regression of human atherosclerotic lesions: two years' follow-up by high-resolution noninvasive magnetic resonance imaging. Circulation 2002;106:2884–2887.PubMedCrossRefGoogle Scholar
  22. 22.
    O'Holleran LW, Kennelly MM, McClurken M, Johnson JM, Natural history of asymptomatic carotid plaque. Five year follow-up study. Am J Surg 1987;154:659–662.PubMedCrossRefGoogle Scholar
  23. 23.
    Campbell CL, Smyth S, Montalescot G, Steinhubl SR, Aspirin dose for the prevention of cardiovascular disease: a systematic review. JAMA 2007;297:2018–2024.PubMedCrossRefGoogle Scholar
  24. 24.
    The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. International Stroke Trial Collaborative Group. Lancet 1997;349:1569–1581.PubMedCrossRefGoogle Scholar
  25. 25.
    CAST: randomised placebo-controlled trial of early aspirin use in 20,000 patients with acute ischaemic stroke. CAST (Chinese Acute Stroke Trial) Collaborative Group. Lancet 1997;349:1641–1649.Google Scholar
  26. 26.
    Diener HC, Bogousslavsky J, Brass LM, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet 2004;364:331–337.PubMedCrossRefGoogle Scholar
  27. 27.
    Leonardi-Bee J, Bath PM, Bousser MG, et al. Dipyridamole for preventing recurrent ischemic stroke and other vascular events: a meta-analysis of individual patient data from randomized controlled trials. Stroke 2005;36:162–168.PubMedCrossRefGoogle Scholar
  28. 28.
    Verro P, Gorelick PB, Nguyen D, Aspirin plus dipyridamole versus aspirin for prevention of vascular events after stroke or TIA: a meta-analysis. Stroke 2008;39:1358–1363.PubMedCrossRefGoogle Scholar
  29. 29.
    A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet 1996;348:1329–1339.PubMedCrossRefGoogle Scholar
  30. 30.
    Hart RG, Bhatt DL, Hacke W, et al. Clopidogrel and aspirin versus aspirin alone for the prevention of stroke in patients with a history of atrial fibrillation: subgroup analysis of the CHARISMA randomized trial. Cerebrovasc Dis 2008;25:344–347.PubMedCrossRefGoogle Scholar
  31. 31.
    Sacco RL, Diener HC, Yusuf S, et al. Aspirin and extended-release dipyridamole versus clopidogrel for recurrent stroke. N Engl J Med 2008;359(12):1238–1251.Google Scholar
  32. 32.
    Cholesterol, diastolic blood pressure, and stroke: 13,000 strokes in 450,000 people in 45 prospective cohorts. Prospective studies collaboration. Lancet 1995;346:1647–1653.CrossRefGoogle Scholar
  33. 33.
    Kurth T, Everett BM, Buring JE, Kase CS, Ridker PM, Gaziano JM, Lipid levels and the risk of ischemic stroke in women. Neurology 2007;68:556–562.PubMedCrossRefGoogle Scholar
  34. 34.
    Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK, Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001;345:494–502.PubMedCrossRefGoogle Scholar
  35. 35.
    Plehn JF, Davis BR, Sacks FM, et al. Reduction of stroke incidence after myocardial infarction with pravastatin: the Cholesterol and Recurrent Events (CARE) study. The Care Investigators. Circulation 1999;99:216–223.PubMedCrossRefGoogle Scholar
  36. 36.
    Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994;344:1383–1389.PubMedGoogle Scholar
  37. 37.
    Waters DD, LaRosa JC, Barter P, et al. Effects of high-dose atorvastatin on cerebrovascular events in patients with stable coronary disease in the TNT (treating to new targets) study. J Am Coll Cardiol 2006;48:1793–1799.PubMedCrossRefGoogle Scholar
  38. 38.
    Shepherd J, Blauw GJ, Murphy MB, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet 2002;360:1623–1630.PubMedCrossRefGoogle Scholar
  39. 39.
    O'Regan C, Wu P, Arora P, Perri D, Mills EJ, Statin therapy in stroke prevention: a meta-analysis involving 121,000 patients. Am J Med 2008;121:24–33.PubMedCrossRefGoogle Scholar
  40. 40.
    Amarenco P, Goldstein LB, Szarek M, et al. Effects of intense low-density lipoprotein cholesterol reduction in patients with stroke or transient ischemic attack: the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial. Stroke 2007;38:3198–204.PubMedCrossRefGoogle Scholar
  41. 41.
    Nassief A, Marsh JD, Statin therapy for stroke prevention. Stroke 2008;39:1042–1048.PubMedCrossRefGoogle Scholar
  42. 42.
    Chalmers J, Trials on blood pressure-lowering and secondary stroke prevention. Am J Cardiol 2003;91:3G–8G.PubMedCrossRefGoogle Scholar
  43. 43.
    Turnbull F, Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials. Lancet 2003;362:1527–1535.PubMedCrossRefGoogle Scholar
  44. 44.
    Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet 2001;358:1033–1041.CrossRefGoogle Scholar
  45. 45.
    Staessen JA, Wang JG, Thijs L, Cardiovascular protection and blood pressure reduction: a meta-analysis. Lancet 2001;358:1305–1315.PubMedCrossRefGoogle Scholar
  46. 46.
    Neal B, MacMahon S, Chapman N, Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Blood Pressure Lowering Treatment Trialists' Collaboration. Lancet 2000;356:1955–1964.PubMedCrossRefGoogle Scholar
  47. 47.
    Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. EAFT (European Atrial Fibrillation Trial) Study Group. Lancet 1993;342:1255–1262.PubMedGoogle Scholar
  48. 48.
    Akins PT, Feldman HA, Zoble RG, et al. Secondary stroke prevention with ximelagatran versus warfarin in patients with atrial fibrillation: pooled analysis of SPORTIF III and V clinical trials. Stroke 2007;38:874–880.PubMedCrossRefGoogle Scholar
  49. 49.
    Mohr JP, Thompson JL, Lazar RM, et al. A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke. N Engl J Med 2001;345:1444–1451.PubMedCrossRefGoogle Scholar
  50. 50.
    Halliday A, Mansfield A, Marro J, et al. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet 2004;363:1491–1502.PubMedCrossRefGoogle Scholar
  51. 51.
    Thrombosis prevention trial: randomised trial of low-intensity oral anticoagulation with warfarin and low-dose aspirin in the primary prevention of ischaemic heart disease in men at increased risk. The Medical Research Council's General Practice Research Framework. Lancet 1998;351:233–241.CrossRefGoogle Scholar
  52. 52.
    Hansson L, Zanchetti A, Carruthers SG, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet 1998;351:1755–1762.Google Scholar
  53. 53.
    de Gaetano G, Low-dose aspirin and vitamin E in people at cardiovascular risk: a randomised trial in general practice. Collaborative Group of the Primary Prevention Project. Lancet 2001;357:89–95.PubMedCrossRefGoogle Scholar
  54. 54.
    O'Donnell MJ, Hankey GJ, Eikelboom JW, Antiplatelet therapy for secondary prevention of noncardioembolic ischemic stroke: a critical review. Stroke 2008;39:1638–1646.PubMedCrossRefGoogle Scholar
  55. 55.
    Algra A, Van Gijn J, Koudstaal PJ, Secondary prevention after cerebral ischaemia of presumed arterial origin: is aspirin still the touchstone? J Neurol Neurosurg Psychiatry 1999;66:557–559.PubMedCrossRefGoogle Scholar
  56. 56.
    De Schryver EL, Algra A, van Gijn J, Dipyridamole for preventing stroke and other vascular events in patients with vascular disease. Cochrane Database Syst Rev 2006:CD001820.Google Scholar
  57. 57.
    Adams RJ, Albers G, Alberts MJ, et al. Update to the AHA/ASA recommendations for the prevention of stroke in patients with stroke and transient ischemic attack. Stroke 2008;39:1647–1652.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press, a part of Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Rohit Khurana
    • 1
  • Philip Teal
    • 2
  1. 1.Interventional Cardiology, Vancouver General HospitalVancouverCanada
  2. 2.Department of NeurologyVancouver General Hospital, University of British ColumbiaVancouverCanada

Personalised recommendations