Vol. 9, No 3, 2002 pp. 231 - 235
UC 616:616.133
LIMITING SCREENING OF ASYMPTOMATIC CAROTID
DISEASE
IN PATIENTS WITH SYMPTOMATIC LIMB ISHEMIA
TO SUBGROUP
OF PATIENTS WITH CAROTID BRUIT IS NOT EFFECTIVE
Z. Rančić1, D. Rančić2,
Dj. Radak3, M. Stojiljković1,
N. Djordjević1, M. Pešić1,
G. Stevanović1
1Surgical Clinic, Clinical Center Niš
2Clinic for Otorhinolaryngology, Clinical
Center Niš, Serbia
3Institute for Cardiovascular Disease
"Dedinje", Belgrade, Serbia
E-mail: zorancic@bankerinter.net
Summary. A complete and thorough initial angiologic examination
in patients with symptomatic arterial occlusive disease should include
discovery of a previously undetected carotid bruit.
The aim of our study was to establish characteristics of asymptomatic
carotid bruit based on physical examination and color-flow duplex scanning.
We screened asymptomatic carotid artery disease in 109 patients with symptomatic
peripheral vascular disease treated at University Surgical Clinic in Nis,
and Institute for Cardiovascular Disease "Dedinje" in Belgrade.
Of 109 patients with no symptoms or signs of carotid occlusive disease,
carotid bruit was present in 57 (52%); 17 were unilateral, (10 right and
6 left) and 40 were bilateral. The majority of the patients 27 (47%) were
present with moderate to rough bilateral bruit.
All patients were studied with color-Doppler duplex scanning according
to the criterion of ACAS. Bilateral haemodynamically significant carotid
artery stenosis (CAS) ? 60% was present in 18 (32%) patients, unilateral
in 17 (30%) and in 22 patients (38%) asymptomatic carotid bruit was not
originated from CAS ? 60%.
By univariate analysis significant CAS was associated with carotid
bruit (results were considered significant if p < 0.05). Probability
that CAS ? 60% influenced the prevalence of asymptomatic carotid
bruit, assessed by multivariate stepwise logistic regression analysis,
was confirmed (t = 0.50; p = 0.01). The sensitivity of a carotid bruit
in predicting CAS ? 60% was 67%, with a specificity of 56%. Degree
of internal carotid stenosis was unrelated to plaque morphology.
Limiting screening of haemodynamically significant carotid artery stenosis
to subgroups of patients with asymptomatic carotid bruit is ineffective,
because more than one third of patients with CAS would be excluded in that
way.
Key words: Asymptomatic carotid artery stenosis, carotid
bruit, peripheral vascular disease, screening
RANA DETEKCIJA ASIMPTOMATSKE KAROTIDNE
BOLESTI KOD BOLESNIKA
SA OBLITERANTNOM ATEROSKLEROZOM DONJIH EKSTREMITETA
NA PODGRUPU BOLESNIKA SA KAROTIDNIM SUMOM
NEMA OPRAVDANJA
Kratak sadržaj: Svaki angiološki pregled bolesnika sa ishemijom
donjih ekstremiteta bi trebalo da sadrži i auskultaciju karotidnih arterija
u cilju otkrivanja karotidnog šuma.
Cilj rada je da prikaže karakteristike (kliničke i dupleks sonografske)
asimptomatskog karotidnog šuma. Rano otkrivanje asimptomatske karotidne
stenoze je sprovedeno kod 109 bolesnika lečenih zbog obliterantne
arterioskleroze nogu na Hirurškoj klinic u Nišu i Institutu za kardiovaskularne
bolesti Dedinje u Beogradu.
Od 109 neurološki asimptomatska bolesnika karotidni šum je bio otkriven
kod 57 (52%). Kod 17 bolesnika se radilo o jednostranom, kod 40 obostranom
karotidnom šumu. Kod najvećeg broja bolesnika radilo se o grubom ili umereno
jakom obostranom šumu.
Kolor Doppler dupleks ultrasonografija karotidnih arterija kod bolesnika
sa šumom je pokazala hemodinamski značajnu stenozu obe karotidne arterije
? 60% kod 18 bolesnika (32%), jedne karotidne arterije kod 17 (30%), a
kod 22 bolesnika (38%) stenoza karotidnih arterija je bila manja od 60%.
Stenoza karotidne arterije veće od 60% je statistički značajno udružena
sa šumom nad karotidnom arterijom (p ? 0,05). Ova udruženost je pokazana
i multivarijantnom logističkom regresionom analizom (t=0,50; p=0,01). Medjutim,
senzitivnost karotidnog šuma u predvidjanju karotidne stenoze veće od 60%
iznosi 67, a specifičnost 56%. Ograničenje rane detekcije karotidne stenoze
kod bolesnika sa ishemijom donjih ekstremiteta na bolesnike sa karotid-nim
šumom nema opravdanja, jer bi se gotovo jedna trećina bolesnika sa značajnom
stenozom isključilo iz daljeg ispitivanja.
Ključne reči: Asimptomatska stenoza karotidne arterije, karotidni
šum, periferna vaskularna bolest, rana detekcija
