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Resumo Contexto Artérias carótidas são locais de frequentes patologias, sendo a mais comum a aterosclerose, podendo resultar na formação de placas com estenose. Para avaliarmos as carótidas em pacientes assintomáticos, o método de ultrassonografia Doppler ou ecodoppler é, atualmente, o exame de eleição, indicado para a triagem e o diagnóstico de lesões vasculares. As diretrizes atuais recomendam o rastreamento em pacientes que apresentem fatores de risco para estenose carotídea e que estejam aptos e dispostos ao tratamento medicamentoso/intervenção carotídea. A triagem em pacientes assintomáticos na população adulta em geral e sem fatores de risco significativos não é recomendada. Objetivos Avaliar se os especialistas médicos se baseiam na literatura para solicitar o ecodoppler como screening. Métodos Realizou-se seleção retrospectiva dos pacientes a partir da solicitação de ecodoppler. Os dados coletados foram computados e analisados com o programa RStudio versão 1.3.959. Resultados Avaliou-se a solicitação como adequada, desde que os pacientes apresentassem pelo menos um fator de risco para placas carotídeas. Entre 152 pacientes, 55 preenchiam critérios para screening de carótidas, a principal indicação na população estudada foi o check-up vascular. Hipertensão arterial foi o fator de risco mais prevalente. Os especialistas em cirurgia vascular obtiveram êxito maior ao solicitar o exame de maneira adequada [razão de chances de indicações corretas de 3,52 (IC 1,14-10,87), com p = 0,02]. A assertividade nas indicações de ecodoppler foi de 36% (IC95% 29-42%). Conclusões Conclui-se que houve excesso de solicitação de ultrassonografia de carótidas como screening. Os cirurgiões vasculares solicitaram o exame de maneira mais assertiva.
Abstract Background Carotid arteries are frequently the site of pathologies, the most common being atherosclerosis, which may result in the formation of plaques, causing stenosis. Doppler ultrasound is currently the exam of choice for assessment of the carotid arteries in asymptomatic patients to screen for and diagnose vascular lesions. Current guidelines recommend screening patients who have risk factors for carotid stenosis and who are able and willing to undergo medical treatment and/or carotid intervention. Screening asymptomatic patients in the general adult population who have no significant risk factors is not recommended. Objectives To assess whether medical experts rely on the literature to request Doppler ultrasound for screening. Methods A retrospective selection of patients was performed based on requests for carotid ultrasound. The data collected were computed and analyzed using RStudio version 1.3.959. Results The request was evaluated as appropriate as long as the patients presented at least one risk factor for carotid plaques. Fifty-five out of 152 patients met criteria for carotid screening. The most frequent indication in the study population was vascular check-up. Arterial hypertension was the most prevalent risk factor. Vascular surgery specialists were more likely to order the exam correctly (odds ratio for correct indications: 3.52 [CI 1.14 - 10.87], with p=0.02). The rate of correct Doppler ultrasound requests was 36% (95%CI 29 to 42%). Conclusions An excess of requests for carotid ultrasound screening was found in this study. Vascular surgeons more often requested the test correctly.
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Objective To study the relationship between homocysteine (Hcy)and carotid atherosclerosis in patients with cer-ebral infarction.Methods During January and November 2013,281 patients with cerebral infarction from Affiliated Hospital of Yan’an University were provided the blood samples as cerebral infarction group,140 healthy volunteers served as control group.Serum Hcy was detected by enzymatic cycle assay.According to the results of carotid artery ultrasonography,cerebral infarction group was divided into five groups:artery normal group,intimal thickening group,soft plaque group,mixed plaque group and hard plaque group.The statistically significance was analyzed by SPSS 19.0.Results The serum Hcy level of cer-ebral infarction group was 19.78 ± 5.21 μmol/L,significantly higher than the control group 10.24 ± 3.33 μmol/L (P <0.001).The serum Hcy levels of control group,artery normal group,intimal thickening group,soft plaque group,mixed plaque group and hard plaque group were 10.24±3.33,15.20±2.99,17.03±1.85,25.44±4.24,19.65±4.74 and 18.31 ±3.67 μmol/L respectively.The differences between groups were statistically significant in addition to intimal thickening group and hard plaque group (P =1.106).The positive rates were 16.4%,53.7%,87.1%,95.7%,83.1% and 77.3% re-spectively,the groups which in cerebral infarction group compared with control group,the differences were statistically sig-nificant (P <0.001).Conclusion Hcy played an important role in the occurrence and development of cerebral infarction. Lower serum Hcy concentration,may be an effective way to prevent carotid atherosclerosis and cerebral infarction.