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(Stroke. 2007;38:2887.)
© 2007 American Heart Association, Inc.

Original Contributions

Progression of Carotid Stenosis Detected by Duplex Ultrasonography Predicts Adverse Outcomes in Cardiovascular High-Risk Patients

Schila Sabeti, MD; Oliver Schlager, MD; Markus Exner, MD; Wolfgang Mlekusch, MD; Jasmin Amighi, MD; Petra Dick, MD; Gerald Maurer, MD; Kurt Huber, MD; Renate Koppensteiner, MD; Oswald Wagner, MD; Erich Minar, MD Martin Schillinger, MD

From the Departments of Angiology and Medicine (S.S., O.S., W.M., J.A., P.D., R.K., E.M., M.S.), Chemical Laboratory Diagnostics (M.E., O.W.), and Cardiology (G.M.), Medical University Vienna, and the Third Department of Internal Medicine (K.H.), Cardiology, Wilhelminenhospital, Vienna, Austria.

Correspondence to Martin Schillinger, MD, Department of Internal Medicine II, Division of Angiology, Medical University Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. E-mail martin.schillinger{at}meduniwien.ac.at

Background and Purpose— The progression of carotid stenosis reflects the activity of atherosclerotic disease and may indicate a risk for systemic atherothrombotic complications. We investigated whether progressive carotid stenosis determined by duplex ultrasonography predicts adverse outcomes in cardiovascular high-risk patients.

Methods— We prospectively studied 1065 of 1268 consecutive patients initially asymptomatic with respect to carotid disease. Carotid ultrasound investigations at baseline and after a median of 7.5 months (range, 6 to 9 months) were performed to identify patients with progressive stenosis as defined by Doppler velocity criteria. Patients were then followed up clinically for a median of 3.2 years for the occurrence of major adverse cardiovascular events (composite MACEs: myocardial infarction, percutaneous coronary or peripheral interventions, coronary or vascular surgery, amputation, stroke, and all-cause mortality).

Results— We found progressive carotid stenosis in 93 patients (9%) by ultrasound and thereafter recorded 495 MACEs in 421 patients (40%) during clinical follow-up. Patients with progressive carotid stenosis had a significantly increased risk for cardiovascular events compared with patients with nonprogressive disease: adjusted hazard ratios and confidence intervals were 2.01 for composite MACEs (95% CI, 1.48 to 2.67, P<0.001), 2.38 for myocardial infarction (95% CI, 1.07 to 5.35, P=0.044), 1.59 for any coronary event (95% CI, 1.10 to 2.28, P=0.011), 2.00 for stroke (95% CI, 1.02 to 4.11, P=0.035), 2.42 for any peripheral vascular event (95% CI, 1.61 to 3.62, P<0.001), and 1.75 for cardiovascular death (95% CI, 1.03 to 2.97, P=0.039).

Conclusion— Progression of carotid stenosis within a 6- to 9-month interval detected by duplex ultrasound predicts midterm clinical adverse events of atherosclerosis in high-risk patients affecting the coronary, cerebrovascular, and peripheral circulations.

Key Words: carotid artery • carotid stenosis • stroke • ultrasound

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