Document Detail

Predictive power of duplex ultrasonography in asymptomatic carotid disease.
MedLine Citation:
PMID:  9214247     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Duplex ultrasonography is considered a valid measure of stenosis of the carotid arteries, but the prognostic value of repeated ultrasonographic examinations is unknown. OBJECTIVE: To determine the ability of serial ultrasonographic measurements to predict cerebrovascular events in patients with asymptomatic carotid disease. DESIGN: Secondary analysis of data from a natural history study of asymptomatic carotid disease. PATIENTS: Asymptomatic patients with cervical bruits. MEASUREMENTS: Duplex ultrasonography of the carotid arteries was done at study enrollment and biannually thereafter. Multivariable Cox proportional hazards models with fixed and time-dependent covariates were used for analysis. RESULTS: 61 transient ischemic attacks (TIAs) and 38 strokes occurred in 715 participants over a mean follow-up period of 3.2 years; 4 strokes were disabling, and no deaths from stroke occurred. Sixty percent of strokes occurred in persons who did not have severe stenosis. One fifth of participants had stenosis progression. Baseline carotid stenosis was a significant predictor of the outcome "TIA or stroke" (relative risk, 1.5 [95% CI, 1.2 to 1.7]) and retained its predictive ability for more than 3 years. Progression of stenosis to 80% or more significantly increased the risk for cerebrovascular events and death. The sensitivity and positive predictive value of progression as an independent predictor of TIA or stroke were low. CONCLUSION: Severe carotid stenosis is associated with a higher risk for cerebrovascular events, but the power of repeated ultrasonography to predict ischemic events is limited by low incidence rates and low rates of progression. The evidence does not support the routine use of serial ultrasonography to determine the risk for stroke in unselected patients with asymptomatic carotid disease.
R F Lewis; M Abrahamowicz; R Côté; R N Battista
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of internal medicine     Volume:  127     ISSN:  0003-4819     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  1997 Jul 
Date Detail:
Created Date:  1997-07-03     Completed Date:  1997-07-03     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  13-20     Citation Subset:  AIM; IM    
McGill University, Montreal, Quebec, Canada.
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MeSH Terms
Aged, 80 and over
Carotid Stenosis / complications,  mortality,  ultrasonography*
Cerebrovascular Disorders / etiology
Disease Progression
Double-Blind Method
Follow-Up Studies
Ischemic Attack, Transient / etiology
Middle Aged
Predictive Value of Tests
Proportional Hazards Models
Prospective Studies
Risk Factors
Ultrasonography, Doppler, Duplex*
Comment In:
ACP J Club. 1998 Jan-Feb;128(1):12

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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