Carotid artery atherosclerosis, ischemic

Homer D, Ingall TJ, Baker HL et al. (1991). Serum lipids and lipoproteins are less powerful predictors of extracranial carotid artery atherosclerosis than are cigarette smoking and hypertension. Mayo Clinic Proceedings 66 259-267 Hooper L, Capps N, Clements G et al. (2004). Foods or supplements rich in omega-3 fatty acids for preventing cardiovascular disease in patients with ischemic heart disease. 

The clinical manifestations of PAD are associated with reduction in functional capacity and quality of life, but because of the systemic nature of the atherosclerotic process there is a strong association with coronary and carotid artery disease. Consequently, patients with PAD have an increased risk of cardiovascular and cerebrovascular ischemic events [myocardial infarction (Ml), ischemic stroke, and death] compared to the general population (4,5). In addition, these cardiovascular ischemic events are more frequent than ischemic limb events in any lower extremity PAD cohort, whether individuals present without symptoms or with atypical leg pain, classic claudication, or critical limb ischemia (6). Therefore, aggressive treatment of known risk factors for progression of atherosclerosis is warranted. In addition to tobacco cessation, encouragement of daily exercise and use of a low cholesterol, low salt diet, PAD patients should be offered therapies to reduce lipid levels, control blood pressure, control blood glucose in patients with diabetes mellitus, and offer other effective antiatherosclerotic strategies. A recent position paper... 

The study of cerebrovascular disease has advanced markedly in recent years with advances in non-invasive imaging methods such as MR angiography and CT angiography as well as an improved understanding of the immune system in the pathogenesis of atherosclerosis. Atherosclerotic cerebrovascular disease is a common cause of strokes and shows a predilection for sites such as the bifurcation of the common carotid artery into the internal and external carotid arteries and the aortic arch and the major intracranial arteries such as the basilar artery and the middle cerebral arteries. Occlusive atherosclerotic vascular disease of these large extracranial arteries is responsible for as many as 20-30% of ischemic strokes and intracranial steno-occlusive disease causes around 5-10% of ischemic strokes. 

Atherosclerosis of the carotid artery represents an important risk for ischemic strokes. Therapeu-... 

In addition to coronary sclerosis, evidence is accumulating that high Lp(a) levels may be important in the development of cerebrovascular and peripheral arterial disease, as well (J6, T8, U2). Lp(a) levels not only correlated well with clinical endpoints such as transient ischemic attack and cerebral infarction, but also were associated with the extent and severity of carotid atherosclerosis, as assessed by bidirectional Doppler ultrasound (K23, M33, Z2). 

Patients who have had a stroke or transitory ischemic attack associated with intracranial artery stenosis (>50%) have a 12-14% risk of subsequent stroke in the 2-year period after the initial event, regardless of treatment with antithrombotic medications. Atherosclerosis in the intracranial portion of the ICA and the MCA is more common in the African-American, Hispanic, and Asian populations for unknown reasons. The proportion of patients hospitalized for ischemic strokes with symptomatic intracranial stenosis ranges from 1% in non-Hispanic whites to as high as 50% in Asian populations [21, 22]. Atherosclerosis in the intracranial portion of the carotid and in the MCA often causes multiple strokes in the same vascular territory. It may also cause slow stroke syndrome, in which there is progressive worsening of focal cortical ischemic symptoms over days or weeks. In addition, the penetrator arteries flowing to the deep white matter and striatum originate from the MCA stem (Ml) and may be occluded in patients with severe MCA stenosis [20]. 

---