The authors studied by carotid duplex ultrasonography 478 unselected el derly patients (age sixty to one hundred one years, mean 82±8), in their long- term health care facility. Of these, 108 had previously experienced strokes owing to atherothrombotic brain infarcts, documented by a neurologist, and 370 had not. The degree of extracranial internal or common carotid narrowing in these patients was classified by standard Vmax Doppler criteria as 0-40%, 40- 80%, and 80-100% luminal diameter reduction.
The authors found that 87% of the patients had little or no carotid stenosis (0-40% luminal diameter reduction). Nevertheless, 79% of the previous strokes had occurred in these patients, and the incidence of strokes in this group was 21%. Severe, but not mild or moderate, degrees of carotid obstruction (80- 100% luminal diameter reduction) were associated with a 100% stroke inci dence.
The authors conclude that strokes most commonly result from causes other than ischemia due to in situ severe extracranial internal or common carotid stenosis or occlusion.
Moosey J.: Cerebral infarcts and the lesions of intracranial and extracranial atherosclerosis . Arch Neurol14:120-125, 1966.
3.
Warlow C.: Carotid endarterectomy: Does it work?Stroke15:1068-1076, 1984.
4.
Schoenfeld MR , Aronow WS, Paul P.: Are systolic cervical bruits clinically significant findings in the elderly? J Cardiovasc Ultrason6:269-271, 1987.
5.
Aronow WS, Starling L., Etienne F., et al: Risk factors for atherothrombotic brain infarction in persons over 62 years of age in a long-term health care facility. J Am Geriatr Soc35:1-3, 1987.
6.
Chambers BR, Norris JW: Outcome in patients with asymptomatic neck bruits. N Engl J Med315:860-865, 1986.
7.
Powers WJ, Press GA, Grubb RL Jr, et al: The effect of hemodynamically significant carotid artery disease on the hemodynamic status of the cerebral circulation. Ann Int Med106:27-35, 1987.
