This document discusses the prevalence of carotid artery atherosclerosis and stenosis in patients with peripheral arterial disease (PAD). The main points are: 1) Over 85% of patients with PAD also had carotid plaques, indicating a high rate of co-occurrence of carotid and peripheral atherosclerosis. 2) 11.68% of patients with symptomatic PAD had significant carotid stenosis (>50%), compared to 4% of patients without PAD, showing PAD patients have an increased risk of carotid stenosis. 3) Screening for asymptomatic carotid stenosis is important for PAD patients, especially those with an ankle-brachial index <0.7, as the prevalence of asymptomatic carotid stenosis increases with lower ABI values.

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.

7. Carotid stenosis >70%: 14%

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

12. PAD diagnostic

13. Car-US
Plaque
Stenosis
Occlusion
Stenosis

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

16. Results

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

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

22. Ex.-Carotid stenosis in PAD

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