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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Patients presenting with symptoms suggestive of amaurosis fugax, or with findings of Hollenhorst plaques on fundoscopy are frequently referred for duplex evaluation to detect possible carotid artery disease. To better determine the reliability of monocular visual loss and the presence of Hollenhorst plaques for predicting the presence or significance of carotid artery stenosis, we prospectively studied 66 patients with these ocular signs and symptoms. After evaluation, the patients were categorized as follows: 34 of 66 (52%) patients had amaurosis fugax, 23 (35%) had asymptomatic Hollenhorst plaques, 7 (11%) had retinal artery occlusion, and 2 (3%) had venous stasis retinopathy. All patients were evaluated ophthalmologically, with carotid duplex scanning and spectral analysis. A stenosis of greater than 60% was regarded as significant. The presence of risk factors including hypertension, diabetes, a history of CVA or TIA's, tobacco use and hyperlipidemia was recorded. There were no statistically significant differences (p greater than 0.05) in the incidence of atherosclerotic risk factors between the four groups. Patients with amaurosis fugax were more likely to have a significant carotid artery stenosis than those with asymptomatic Hollenhorst plaques or retinal artery occlusion (53% vs 9% vs 0% respectively) (p less than 0.006). We conclude that routine carotid duplex scanning is indicated in all patients with amaurosis fugax in view of the frequent association with significant carotid stenosis (53%). However, the presence of Hollenhorst plaques in the absence of visual symptoms appears not to have a significant association with carotid disease and may not necessarily require routine screening unless other risk factors for carotid stenosis are present.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Correlation of ophthalmic findings with carotid artery stenosis. 152 43

We have studied the incidence of postoperative recurrent stenosis and occlusion in 286 patients, following 320 carotid endarterectomies, all of whom were commenced on low dose aspirin postoperatively. Two hundred and thirty patients (242 procedures) were examined clinically and by duplex scanning on at least two occasions at a minimum of six months apart. The crude incidence of significant recurrent carotid disease was 9.1% (22 out of 242). Seven of 22 vessels had recurrent disease detected within 24 months of operation, representing a crude incidence of 2.9% and a cumulative incidence of 4.2% at two years. The remainder developed recurrent disease after this time. Multivariate analysis of risk factors for recurrent carotid disease following carotid endarterectomy showed that a history of hypertension was significant (p = 0.001). The incidence of ipsilateral neurological events was 7.4% and was related to the presence of recurrent carotid disease (p less than 0.001).
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PMID:The incidence of recurrent carotid stenosis after carotid endarterectomy and its relationship to neurological events. 154 97

Cerebrovascular disease is the most important cause of mortality and morbility in some European Countries, but the prevalence of carotid occlusive disease has not been adequately assessed. From 1985 to 1987, 1,143 patients were consecutively evaluated in the Vascular Laboratory in order to determine the presence of extracranial carotid occlusive disease. 638 (55.8%) were males and 505 (44.2%) females and mean age was 58 years (16-87). 509 had previously focal brain ischemia, ocular and/or hemispheric (Group I), 78 had assymptomatic cervical bruit (Group II), 55 non-hemispheric neurologic dysfunction (Group III) and 501 had atypical symptoms for cerebrovascular disease (Group IV). Diagnostic criteria for carotid disease: were peak frequency greater than 4.0 KHz; spectral broadening greater than 40% and late sysstolic turbulence. Global prevalence of carotid disease was 31.8% and the results in each group were: Gr. I-37.2%; Gr. II-57.7%; Gr. III-43.6%; Gr. IV-21.2%. 49% of the patients had hypertension, 22.8% dyslipidemia, 22.4% evidence of coronary disease and 13.6% had diabetes. Hypertension, diabetes, coronary disease and the coexistence of two risk factors were significantly more prevalent in the group of patients with carotid disease. These results confirm a high prevalence of carotid disease in this population, which is comparable to the one is northern european populations.
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PMID:[Prevalence of extracranial carotid occlusive disease. Non-invasive study]. 157 Jul 56

Optic atrophy can often be a result of arterial blood flow insufficiency associated with systemic vascular disease (cardiovascular disease, hypertension, or diabetes mellitus). The lack of adequate blood perfusion pressure can create conditions leading to anoxia and death of the nerve fiber layer with a resultant visual field defect. A case of a 63-year-old white male is presented with optic atrophy resulting from anterior ischemic optic neuropathy 5 years earlier. A review of the literature concerning the more common causes of ocular vascular insufficiency (i.e., anterior ischemic optic neuropathy, internal carotid disease, central retinal artery occlusion, and branch retinal artery occlusion) as well as diagnostic testing and therapeutic management is discussed.
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PMID:Vascular implications of optic atrophy. 163 40

We noninvasively evaluated the prevalence and severity of atherosclerotic lesions of the internal carotid artery in 146 nonobese, nondiabetic hypertensive patients who were free of cardiovascular symptoms. We found internal carotid artery disease in 63 patients (43%), 26 (18%) with unilateral disease and the other 37 (25%) with bilateral disease. Disease severity was correlated with age but not duration of hypertension, cholesterol level, or current smoking habit. We also followed disease progression and clinical outcome with respect to cardiovascular events for 3 years in a subgroup of 95 unselected patients. In 20 of the 93 survivors (21.5%) we noted progression of the atherosclerotic lesions that was predicted by neither risk factors nor initial status of the internal carotid artery. New neurologic symptoms developed in four survivors (4%) and symptoms of cardiac ischemia in six (6%). No survivor who developed new cerebrovascular symptoms showed progression of carotid disease. These data provide useful elements for a rational approach to prevention of the atherosclerotic complications of hypertension.
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PMID:Noninvasive study of arterial hypertension and carotid atherosclerosis. 230 66

We have evaluated 39 patients with ischemic strokes secondary to atherosclerotic disease of the extracranial carotid artery. Seven of them had been treated in the past with cervical radiotherapy for neoplastic diseases (radiotherapy group); the remaining 32 patients had not received radiation therapy (non-radiotherapy group). When the prevalence of risk factors was compared between the two groups, there was a significantly higher prevalence of peripheral arterial disease (p less than 0.05), hypertension (p less than 0.05) and atherogenicity index lower than 21.5% (p less than 0.05) in the non-radiotherapy group. Regarding angiographic data, the radiotherapy group showed a significantly higher occurrence of localized findings than the non-radiotherapy group (p less than 0.005). It is concluded that radiation-induced carotid disease is a clinical condition which may be individualized from the remaining patients with atherosclerotic carotid artery disease.
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PMID:[Carotid artery disease induced by irradiation]. 262 84

Experience with 1035 carotid endarterectomies in a single community over a 2-year period was analyzed. Twenty-two surgeons working in six hospitals were involved. All surgeons had full-time or part-time appointments at the University of Rochester, 18 had special interest in vascular surgery, and eight had obtained a certificate of qualification in vascular surgery. Mortality rate was 1.4% (14 deaths), with additional permanent, nonfatal, neurologic morbidity of 3.4%. Mortality and morbidity were independent of surgeon, caseload, or hospital. Age and prior history of myocardial infarction influenced the incidence of postoperative myocardial infarction but not the incidence of death or neurologic morbidity. Factors that increased the risk of postoperative death or neurologic complication included hypertension; contralateral carotid disease as manifested by stroke, endarterectomy, or occlusion; whether the patient was a woman; and symptoms of crescendo ischemia. Lack of preoperative neurologic symptoms was correlated with decreased risk of myocardial infarction and neurologic complications. Overall mortality and neurologic morbidity associated with operation for "asymptomatic stenosis" was 3.1% (seven of 222 cases). However, the incidence of contralateral carotid disease was high in the patients in the asymptomatic group (60%), and all complications in this group occurred in patients with prior contralateral carotid endarterectomy or occlusion (p less than 0.05).
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PMID:Risk factors in a community experience with carotid endarterectomy. 276 Sep 95

The risk of stroke in patients with asymptomatic carotid disease appears to be related to the presence of a high-grade stenosis. To determine the prevalence of such lesions, duplex scanning was performed on 348 unselected volunteers without symptoms who attended hospital-sponsored health fairs. There were 209 women and 139 men whose ages ranged from 24 to 91 years. Risk factors included hypertension (37%), diabetes (8%), and smoking (23%). One hundred seven subjects (31%) had evidence of extracranial carotid artery disease, 13 (4%) with greater than 50% stenosis, and three (1%) with greater than 80% stenosis of the internal carotid artery. Bilateral disease was present in 50 patients. Disease prevalence and severity were significantly correlated with age (p less than 0.001) and hypertension (p less than 0.01) but not with diabetes or smoking. The incidence of disease was similar in men and women. Although carotid plaques are common in people older than 50 years of age who do not have symptoms, the prevalence of high-grade stenosis--even in the elderly hypertension population--is low, casting doubt on the cost-effectiveness of generalized screening.
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PMID:Prevalence of asymptomatic carotid disease: results of duplex scanning in 348 unselected volunteers. 305 43

The histopathologic characteristics of primary plaques and recurrent carotid disease were studied in 32 patients. These data were related to symptoms, recurrence interval (6 to 176 months), arteriographic anatomy, and in situ operative findings. A striking predilection was noted for recurrent lesions to be located in the internal carotid artery near the origin, but still within the confines, of the original endarterectomy site and suture line. Although recurrence was frequently associated with a long primary arteriotomy, evidence of technical faults or periarterial fibrosis was rare. Early recurrent lesions (recurrence interval less than 36 months, n = 13) had significantly more smooth muscle cells and proteoglycans (p less than 0.001) than late recurrent lesions (recurrence interval greater than 36 months, n = 19). As previously reported, features of atherosclerosis (abundant collagen, calcium deposits, and foam cells) were more pronounced in late recurrences (p less than 0.001). However, the histopathologic differentiation between early and late recurrent carotid disease was indistinct. A continuum was noted whereby characteristics of late recurrent lesions increased in proportion to recurrence interval. All recurrent lesions were easily distinguished from primary plaques in that recurrences had a less orderly arrangement of all elements and lacked the classic topographic features of advanced atherosclerosis. An important feature that differentiated primary and recurrent lesions was the presence of surface and intraplaque thrombus in 90% of recurrent lesions (p less than 0.001). In early recurrent disease, luminal surface thrombus was striking; this was frequently platelet-rich and showed organization devoid of neovascularity. Intraplaque thrombus was more common in late recurrent disease, consisted almost entirely of fibrin, and was often contiguous with luminal surface thrombus. No discernible relationships were noted between thrombus associated with recurrent lesions and the presence or absence of symptoms, treatment with antiplatelet agents, and hypertension. This finding suggests that thrombus was a continuous and intrinsic component of recurrent disease rather than a secondary, complicating feature. Recurrent carotid disease is a progressive lesion that stems from ongoing thrombogenesis occurring at the endarterectomy site. Organized thrombus and smooth muscle cell proliferation comprise the bulk of the lesion, which undergoes atherosclerotic change with time.
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PMID:Morphogenesis and clinicopathologic characteristics of recurrent carotid disease. 394 78

Since 1966, 29 patients with recurrent carotid artery stenosis have been encountered. The mean (+/- SEM) internal between initial carotid endarterectomy and secondary presentation was 67.5 +/- 9.2 months (range 6 to 180 months). There was a disproportionate number of women with recurrent stenosis. The mean age at initial endarterectomy in patients with recurrent stenosis, 54.6 +/- 1.4 years, was significantly less (P less than 0.001) than that of all patients who had endarterectomy. To define the etiologic factors for recurrence, 21 of these patients were matched with case-control patients of the same age and sex who had undergone endarterectomy the same year but did not develop recognized recurrent stenosis. There was no significant difference in the incidence of hypertension, diabetes mellitus, coronary artery disease, bilateral carotid disease, other vascular operations, or family history for atherosclerosis in patients with recurrent stenosis compared to control patients. The indications for primary endarterectomy, angiographic distribution of disease, and operative details were similar in both groups. There was no difference in the incidence of regular, therapeutic aspirin ingestion following initial endarterectomy (52.5% in both groups). There was a striking difference in smoking habits. Ninety-five percent of patients with recurrent stenosis continued to smoke following initial endarterectomy, compared to 23.8% of control patients (P less than 0.001). Lipid fractionation studies were performed in both groups, and there were no significant differences in levels of cholesterol, triglycerides, high-density lipoprotein (HDL)-cholesterol, and total cholesterol/HDL-cholesterol ratio. Dose-response platelet aggregometry detected no differences between groups in the sensitivity of platelets to adenosine diphosphate (ADP), collagen, and epinephrine. Reoperation in patients with recurrent stenosis was associated with minimal morbidity, no deaths, and generally excellent results.
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PMID:Etiologic factors for recurrent carotid artery stenosis. 682 70


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