engleski

The role of carotid artery disease in ischemic stroke

Stroke is the most significant disease of today. It is the third leading cause of mortality in most western countries, as well as the most important cause of disability in adults and the second largest cause of dementia. Large vessel disease or macroangiopathy makes up for 20% of all strokes. Macroangiopathy is the most prevalent in middle-aged men (~5-70). It can be highly correlated with previous TIAs, smoking and daily alcohol consumption. Patients with stroke caused by macroangiopathy have a greater risk of stroke recurrence and poor outcome is expected in about 20% of all cases. The Tromso Study showed that mortality could be predicted by ultrasound screening. It is believed that each i0% increase in the degree of stenosis increases the risk of cerebrovascular event by 26%. It appears that there is a difference in the risk of stroke in symptomatic and asymptomatic patients with carotid artery disease. The risk of stroke in asymptomatic patients is relatively low, and carotid procedures like carotid angioplasty (CA) or carotid endarterectomy (CEA) are, therefore, not recommended. In symptomatic patients C02 reactivity plays a significant predictor role indicating stroke risk. Exhausted C02 reactivity raises this risk up to 27%, whereas a patient with non-exhausted reactivity has the risk of only 5, 2%. Furthermore, poststenotic velocity and poststenotic lumen narrowing in severe stenosis may be used as prognostic criteria, as well. Some studies, like ACAS, dealt with primary prevention elective endarterectomy, whereas most of the studies dealt with secondary prevention, namely ECST, NASCET,

carotid artery disease; stroke

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