Stroke, Vol 15, 605-613, Copyright © 1984 by American Heart Association
GO Roederer, YE Langlois, KA Jager, JF Primozich, KW Beach, DJ Phillips and DE Strandness Jr
A prospective study was initiated in January 1980 to follow with Duplex
scanning a consecutive series of 167 asymptomatic patients with cervical
bruits. Patients were seen at six month intervals for the first year and
yearly thereafter. Based on previously validated criteria, disease at the
carotid bifurcation was classified into 6 categories: Normal, 1-15%
diameter reduction, 16-49%, 50-79%, 80-99%, and occlusion. Patients were
evaluated to assess: the occurrence of new neurological symptoms, the
stability of the lesions at the carotid bifurcation, and the possible role
of risk indicators on disease changes. During follow-up, ten patients
became symptomatic (6 with TIA's and 4 with stroke). The development of
symptoms was accompanied by disease progression in 8 patients. By life
table analysis, the annual rate occurrence of symptoms was 4%. The mean
annual rate of disease progression to a greater than 50% stenosis was 8%.
When progression in all categories was considered, 60% of the sides showed
some disease aggravation. The presence of or progression to a greater than
80% stenosis was highly correlated (p = 0.00001) with either the
development of a total occlusion of the internal carotid artery or new
symptoms. The major risk factors associated with disease progression were
cigarette smoking, diabetes mellitus, and age. Those patients under 65
years of age were most likely to show progression. Despite high rates of
disease progression, this study further supports the contention that it is
prudent to follow a conservative course in the management of asymptomatic
patients presenting with a cervical bruit.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
The natural history of carotid arterial disease in asymptomatic patients with cervical bruits
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