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Carotid atherosclerosis
in patients with PAD
Alexandru Andritoiu, Cristian Silosi
Emergency Military Hospital
Vascular Medicine Center ,,Queen Mary,,
Craiova-ROMANIA
Background
• Peripheral arterial disease (PAD) and carotid
occlusive disease are both known to be specific
manifestations of atherosclerosis
• Because they have a common cause, it is
reasonable to hypothesize that they should
correlate with each other
• Patients with PAD-high risk for ischemic stroke
• Previous studies have shown that there is a
correlation between the prevalence of PAD and
Car-D
• There are only several reports indicating the
prevalence of carotid stenosis in patients with
PAD
Carotid plaques
in general population
Plaques,
515, 40%
Non-
Plaques,
780, 60%
N = 1295 subjects; Age 40-90 yr;
M 720: F 575
Andritoiu A, 2009
The prevalence of carotid plaques
Age decades
13.79
28.35
43.8
57.14
81.25
0
20
40
60
80
100
40-49 50-59 60-69 70-79 80-89
Age (yr)
Prevalenta%
Andritoiu A 2009
N = 1295 subjects; Age 40-90 yr;
M 720: F 575
Personal results
CAROTID STENOSIS >60%
N=197 pts ITA/ischemic stroke
12%
Andritoiu A, 2009
Asymptomatic and symptomatic patients with PAD have increased
stroke/TIA risk compared with patients without PAD independent of
traditional risk factors.
Moreover, progressive PAD (decline in ABI 0.15 over 5 years) is
associated with increased stroke risk compared with stable PAD.
Carotid stenosis >70%: 14%
Marek J et al. (J Vasc Surg 1996)
N: 188 pts with claudication
ICA stenosis >50%: 21.8%
The ankle-brachial index was highly predictive of the
presence of carotid stenoses in an inverse
relationship (p = 0.001);
Patients older than 65 years of age who had
claudication, an ankle-brachial index less than 0.7, and
a carotid bruit had a 45% incidence of significant
carotid disease.
Poredos P et al. (Int Angiol 2003)
• normal carotid arteries: 7%
• plaques: 70%
• relation between ABI and Carotid plaque
score
Aim of the study
• to establish the prevalence of asymptomatic
carotid artery atherosclerosis/stenosis in
patients with symptomatic PAD
Method
CAR-US
• Plaques
• Evaluation of stenosis >50%
(PSV>125cm/s)
PAD
• ABI (automated measurement-MESI)
• CDUS
• CT-angio
PAD diagnostic
Car-US
Plaque
Stenosis
Occlusion
Stenosis
CVRFs Score
Risc factors SCORE
Smoking
3p
Diabetes mellitus
2
HBP
1p
Dyslipidemia
1p
Total: 7p
Positive>2p
The patients subgroups
• PAD (+)
• N = 77 pts
• Age: 62.3+/-7.57
(47-80) yrs
• M/F: 6.55
• Atherosclerosis
• PAD (-)
• N = 25 pts
• Age: 57.68+/-6.78
(41-79) yrs
• M/F: 2.12
Results
PAD and Carotid plaques
A large variety of plaques
11.7%
85.7%
4%
40%
0
10
20
30
40
50
60
70
80
90
Car plaques Car stenosis
PAD
Non-PAD
Relation Carotid stenosis-ABI
89%
11%
Bilateral PAD
Unilateral PAD
ABI <0.7 in all patients with PAD and carotid stenosis >50%
CVRFs Score and PAD
• Mean score in pts. with PAD: 4.036+/-1.23
• Mean score in pts. non-PAD: 3.4+/-1.84
3 3.5 4 4.5
non-PAD
PAD
P<0.05
RFs in PAD-Carotid stenosis
subgroup
0
1
2
3
4
5
6
7
8
9
10
Smoking HBP DM Dyslipidemia
Ex.-Carotid stenosis in PAD
Conclusions
• Carotid atherosclerosis is frequently associated
with PAD (>85%)
• Carotid stenosis is more frequent in patients
with symptomatic PAD (11,68% vs 4%)
• Screening for asymptomatic carotid stenosis is
absolutely necessary in patients with PAD and
ABI<0.7-Prevalence of asymptomatic carotid
stenosis increases with decreasing ABI
• CDUS is the tool for screening in asymptomatic
high risk patients (PAD, DM, HBP, smokers,
dyslipidemia) or in symptomatic PAD

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Carotid atherosclerosis in patients with PAD

  • 1. Carotid atherosclerosis in patients with PAD Alexandru Andritoiu, Cristian Silosi Emergency Military Hospital Vascular Medicine Center ,,Queen Mary,, Craiova-ROMANIA
  • 2. Background • Peripheral arterial disease (PAD) and carotid occlusive disease are both known to be specific manifestations of atherosclerosis • Because they have a common cause, it is reasonable to hypothesize that they should correlate with each other • Patients with PAD-high risk for ischemic stroke • Previous studies have shown that there is a correlation between the prevalence of PAD and Car-D • There are only several reports indicating the prevalence of carotid stenosis in patients with PAD
  • 3. Carotid plaques in general population Plaques, 515, 40% Non- Plaques, 780, 60% N = 1295 subjects; Age 40-90 yr; M 720: F 575 Andritoiu A, 2009
  • 4. The prevalence of carotid plaques Age decades 13.79 28.35 43.8 57.14 81.25 0 20 40 60 80 100 40-49 50-59 60-69 70-79 80-89 Age (yr) Prevalenta% Andritoiu A 2009 N = 1295 subjects; Age 40-90 yr; M 720: F 575
  • 5. Personal results CAROTID STENOSIS >60% N=197 pts ITA/ischemic stroke 12% Andritoiu A, 2009
  • 6. Asymptomatic and symptomatic patients with PAD have increased stroke/TIA risk compared with patients without PAD independent of traditional risk factors. Moreover, progressive PAD (decline in ABI 0.15 over 5 years) is associated with increased stroke risk compared with stable PAD.
  • 8. Marek J et al. (J Vasc Surg 1996) N: 188 pts with claudication ICA stenosis >50%: 21.8% The ankle-brachial index was highly predictive of the presence of carotid stenoses in an inverse relationship (p = 0.001); Patients older than 65 years of age who had claudication, an ankle-brachial index less than 0.7, and a carotid bruit had a 45% incidence of significant carotid disease.
  • 9. Poredos P et al. (Int Angiol 2003) • normal carotid arteries: 7% • plaques: 70% • relation between ABI and Carotid plaque score
  • 10. Aim of the study • to establish the prevalence of asymptomatic carotid artery atherosclerosis/stenosis in patients with symptomatic PAD
  • 11. Method CAR-US • Plaques • Evaluation of stenosis >50% (PSV>125cm/s) PAD • ABI (automated measurement-MESI) • CDUS • CT-angio
  • 14. CVRFs Score Risc factors SCORE Smoking 3p Diabetes mellitus 2 HBP 1p Dyslipidemia 1p Total: 7p Positive>2p
  • 15. The patients subgroups • PAD (+) • N = 77 pts • Age: 62.3+/-7.57 (47-80) yrs • M/F: 6.55 • Atherosclerosis • PAD (-) • N = 25 pts • Age: 57.68+/-6.78 (41-79) yrs • M/F: 2.12
  • 17. PAD and Carotid plaques A large variety of plaques 11.7% 85.7% 4% 40% 0 10 20 30 40 50 60 70 80 90 Car plaques Car stenosis PAD Non-PAD
  • 18.
  • 19. Relation Carotid stenosis-ABI 89% 11% Bilateral PAD Unilateral PAD ABI <0.7 in all patients with PAD and carotid stenosis >50%
  • 20. CVRFs Score and PAD • Mean score in pts. with PAD: 4.036+/-1.23 • Mean score in pts. non-PAD: 3.4+/-1.84 3 3.5 4 4.5 non-PAD PAD P<0.05
  • 21. RFs in PAD-Carotid stenosis subgroup 0 1 2 3 4 5 6 7 8 9 10 Smoking HBP DM Dyslipidemia
  • 23. Conclusions • Carotid atherosclerosis is frequently associated with PAD (>85%) • Carotid stenosis is more frequent in patients with symptomatic PAD (11,68% vs 4%) • Screening for asymptomatic carotid stenosis is absolutely necessary in patients with PAD and ABI<0.7-Prevalence of asymptomatic carotid stenosis increases with decreasing ABI • CDUS is the tool for screening in asymptomatic high risk patients (PAD, DM, HBP, smokers, dyslipidemia) or in symptomatic PAD