Ultrasound of Neck Arteries May Help Gauge Stroke
WEDNESDAY, Aug. 17 (HealthDay News) -- People who have narrowed
carotid arteries in the neck and show no symptoms may be at risk
for stroke and not know it, but a simple ultrasound test can
identify the problem, a new study suggests.
This condition, known as asymptomatic carotid stenosis, is
caused by plaque build-up in the arteries that carry blood from the
heart to the brain. This can cause less blood to reach the brain
and, in rare cases, may also trigger a stroke if plaque breaks off
and becomes lodged in the small vessels in the brain.
"Only a small minority of patients with carotid stenosis will suffer a stroke," said lead researcher Dr. Raffi Topakian, from the Academic Teaching Hospital Wagner-Jauregg in Linz, Austria.
The problem is identifying the patients at the highest risk for
stroke, he said. Most patients with carotid stenosis can be managed
with medications such as cholesterol-lowering drugs, blood
pressure-lowering drugs and blood thinners such as aspirin, he
But those at highest risk may need a surgical procedure called
an endarterectomy, which clears the carotid arteries of plaque.
"We found with two ultrasound methods we could differentiate the patients who are at very low risk of suffering a stroke -- lower than 1 percent per year -- from patients at high risk of stroke -- higher than 8 percent per year," Topakian said.
The patients who are at high risk are candidates for surgery, he
said. Endarterectomy is not recommended for most people with
carotid stenosis since the problem can be managed with drugs and
there are risks, including stroke, with the procedure, Topakian
Those who would benefit from the ultrasound test are people with
known carotid stenosis who are fit for surgery, Topakian said. "If
they are too sick or frail for surgery, it makes no sense to do the
ultrasound," he said.
In addition, people at high risk for stroke are also candidates
for ultrasound, Topakian said. This would include people with high
cholesterol, high blood pressure or heart disease, he said. "This
test could be a good tool to identify the right patients for
surgery," Topakian said.
Of course, anyone with symptomatic carotid stenosis is a
candidate for immediate surgery, Topakian said. Warning signs
include transient ischemic attacks (TIAS), or mini-strokes, which
cause no permanent damage but are often followed by a stroke within
a few days.
The report was published in the Aug. 17 online edition of
For the study, a research team led by Topakian followed 435
people with asymptomatic carotid stenosis for two years.
Each participant had an ultrasound to see if there were signs
that a stroke might occur. These included tiny blood clots, which
pass into the brain, and a type of plaque called echolucent plaque,
which is fattier than other plaque and linked with an increased
risk for stroke.
Among those in the study, 38 percent had the fattier-than-normal
plaque, 17 percent had signs of blood clots and 27 percent had both
the fattier plaque and blood clots, the researchers found.
In addition, over the two years of the study, 10 people had
Moreover, people with the fattier plaque were more than six
times more likely to have a stroke than those people without the
plaque, and those with the fattier plaque and clots had a risk that
was 10 times higher, Topakian's team found.
Nonetheless, some experts said that research suggests that
patients with no symptoms are better off without the surgery.
Dr. Lars Marquardt,a professor of surgery at the University of
Erlangen-Nuremberg in Germany and co-author of an accompanying
journal editorial, said surgery for people with asymptomatic
carotid steno sis is done too frequently.
Marquardt noted that the risks associated with the surgery are a
lot higher than leaving the stenosis as it is and starting
aggressive medical treatment.
"Patients with symptomatic carotid stenosis don't get the surgical procedure early enough, and patients with asymptomatic carotid stenosis have too many surgical interventions," Marquardt said.
When treating asymptomatic carotid stenosis, Marquardt doesn't
think the case has been made for distinguishing between high- and
low-risk patients. Right now, the work done by Topakian's group is
still "experimental," he said.
Another expert, Dr. Larry B. Goldstein, director of the Duke
University Stroke Center, said that "what remains uncertain is
whether surgical intervention would result in an overall
improvement in stroke-free survival."
"It is also unclear how optimal medical management [lifestyle changes in addition to anti-platelet medication and statins] would affect overall stroke and cardiovascular risk, and stroke-free survival," he said.
Both the U.S. Preventive Services Task Force and the American
Heart Association currently recommend against general population
screening for asymptomatic carotid artery stenosis, Goldstein
For more information on stroke, visit the
U.S. National Library of Medicine.
Copyright © 2011
. All rights reserved.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.