Which asymptomatic patients should undergo routine screening carotid duplex scan?

Article Abstract:

Stroke, or cerebrovascular accident, is a sudden loss of consciousness followed by paralysis. It is caused by occlusion of an artery or cerebrovascular hemorrhage, which results in ischemia (deficiency of blood supply) affecting brain tissue normally passed through by the damaged or blocked vessels. This is a potentially preventable condition. Patients who have neurologic symptoms or bruits (noises) over the carotid arteries (main arterial supply for the brain) may undergo duplex scan of the carotid artery. Duplex scan is a noninvasive study combining real-time ultrasound and pulse-gated Doppler imaging, which accurately measures blood flow. A study was undertaken to determine if patients with peripheral vascular occlusive disease who did not have symptoms of carotid artery disease should undergo routine carotid duplex scanning. A retrospective review was performed of all 4,000 carotid duplex scans performed in one vascular laboratory over a four-year period. This review identified 91 scans performed on 78 patients who had peripheral artery disease but no signs or symptoms of carotid artery disease. Carotid artery narrowing of between 16 and 50 percent was noted in 33 percent of patients. Significant narrowing (greater than 50 percent) was noted in 14 percent of patients, and 5 percent of patients had narrowing over 75 percent. Of the 11 patients noted to have significant narrowing, all were at least 68 years old. A combination of age of 68 or older and other established risk factors for atherosclerosis (coronary artery disease, hypertension, diabetes, smoking or history of heart or vascular surgery) increased the incidence of significant carotid narrowing to 45 percent. It is concluded that routine screening using carotid duplex scanning is indicated in all patients 68 years or older who have peripheral artery disease, when other risk factors for atherosclerosis are present. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Medical screening, Health screening, Carotid artery diseases, Duplex ultrasonography

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Impact of changing attitudes in carotid surgery on community hospital practice

Article Abstract:

Stroke is caused by blockage of an artery or cerebrovascular hemorrhage, which results in a deficiency of blood supply to brain tissue normally passed through by the damaged or blocked vessels. This is a potentially preventable condition. For example, carotid artery reconstruction can prevent stroke. Since most of these reconstructive operations are performed in community hospitals, it is important that results from these institutions be reported, as well as from large teaching hospitals. A report is presented of five-years experience at two community hospitals. Just prior to the study period, guidelines had been established for this surgery. Indications for surgery included artery narrowing associated with symptoms, or asymptomatic narrowing of more than 90 percent or progression to occlusion. There were 159 carotid reconstructions performed during the study period; only one case did not meet the established guidelines. Four patients had major stroke, and one of these patients died. A second patient died from a heart attack. The combined incidence of stroke/death was 3 percent. In 1985, 44 carotid reconstructions were performed, while in 1989, only 26 were performed. It is concluded that the number of these procedures decreased in the late 1980s, even though carotid surgery can safely be performed in the community hospital. The quality assurance program of a community hospital can be improved by establishment of procedure guidelines. (Consumer Summary produced by Reliance Medical Information, Inc.)

Standards, Evaluation, Medical care, Surgery

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