Risk factors for cerebrovascular events: end-diastolic flow velocity.

INTRODUCTION: There are very few studies analysing blood flow velocity parameters of common carotid arteries (CCA), obtained with color Doppler examination as a predictor in cerebrovascular events (CVE). In everyday clinical practice there are number of patients (pts) without carotid stenosis or occlusion but with decreased blood flow velocities. AIM: We performed this study to compare data of velocity parameters with type of cerebrovascular events (CVE) and multiple risk factors in patients without stenotic or occlusive extracranial disease. METHODS: We included total of 127 consecutive patients who experienced various subtypes of cerebrovascular events, 68 females, 59 males, mean age 70.2 +/- SD 12.4 years, out of them 48 pts. had transients ischemic attacs (TIAs), 31 pts. had recurrent TIAs (recTIAs), 32 pts. developed ischemic stroke (IS), and 16 recurrent IS (recIS). All patients were without hemodynamically significant carotid stenosis or occlusion. As a control group we took 50 patients with comparable mean age and gender distribution, all without cerebrovascular events, but with at least 1 multiple risk factor. We included the following clinical variables: age, gender, hypertension, tobacco smoking, hyperlipidemia, obesity, diabetes mellitus. Velocity parameters were: peak-systolic velocity (PSV), end-diastolic velocity (EDV), pulsatility index (PI), resistive index (RI). Examination was performed on distal portion of CCA, and we took the mean of both CCA. RESULTS: Hemodynamic parameters in CVE pts were: PSV 83.5 cm/sec, EDV 19.5 cm/sec, PI 1.54, and RI 0.77, and in Controls values were: PSV 87.5 cm/sec, EDV 28.5 cm/sec, PI 1.42, RI 0.67, respectively. No sign. diff. in PSV and PI were found between CVE (n=127) and Controls (n=50), p = 0.2, while difference in EDV was significant, p < 0.01. We found significance for the following variables: age, tobacco smoking, hypertension, hyperlipidemia and obesity. The best single predictors for CVE were: age (70.1%, p < 0.01), tobacco smoking (63%, p < 0.01, hypertension (52.8%, p < 0.01) and obesity (51.2%, p < 0.01). and among hemodynamic parameters, end-diastolic velocity less than 18 cm/sec (p < 0.05). Decreased EDV (below 18 cm/sec) revealed a significant association with CVE. CONCLUSIONS: (a) we found significantly lower EDV in pts with IS and recIS, (b) EDV below 18 cm/sec was the best single predictor of IS, and recIS, (c) in our CVE pts--age, tobacco smoking, hypertension, obesity, were the best single predictors for CVE.

[Subclavian steal carotid recovery syndrome--case report]. / Subclavian steal carotid recovery syndrom--prikaz slucaja.

A case of atherosclerotic changes with rare form of right sided Subclavian Steal Carotid Recovery Syndrom consisted of three elements: critical stenosis of brachiocephalic trunc (80%), mild stenosis of right common carotid artery (35%) and variable, ascendent-descendental filling of right vertebral artery is reported. A patient is in a high risk for developing of arterial occlusive disease and with high total score of 7 out of 10 multiple risk factors (age, personal or familiar history, smoking, hyperlipidaemia, overweight, sedentary lifestyle). A cervical spondylosis accompanied with chronic neural lesion of C7/C8 myotom is verified causing mistreatment of a patient exclusively as neurological or physiatrical case.

[Multivascular atherosclerosis, the Sarajevo Vascular Study]. / Polivaskularna aterosklerotska bolest, sarajevska vaskularna studija.

INTRODUCTION: We started with Sarajevo Vascular Study (SVS) in 1994 with basic aim to evaluate arterial occlusive disease (AOD) of lower extremities and investigate possible effect of amelioration of risk factors to atherosclerosis regression. In 1996 we expanded SVS to polyvascular atherosclerotic disease, asymptomatic or symptomatic atherosclerotic disease on various vascular beds i.e. lower extremity arterial occlusive disease (AOD), cerebrovascular disease (CVD), coronary artery disease (CAD). We enrolled a total of 1680 pts. in the study but this number has changed depending on war migrations, comorbidity, or paramedical reasons. Follow-up of 10 yrs. had 645 pts, and follow-up of 8 yrs. had 1035 pts. METHOD: We enrolled a total of 1680 pts, 954 pts with symptomatic disease, and 246 pts without atherosclerotic disease but with at least 3/8 multiple risk factors (MRF), and as controls 400 pts without vascular disease and less than 3 MRF. STUDY DESIGN: one center, prospective, consecutive, with evaluation of epidemiological data--gender, age, comorbidity, antropometrical data, hemodynamic data--systolic and dystolic velocities, pulsatility and resistive indices, and morphologic data. Clinical variables--gender, age, hypertension, smoking, hyperlipoproteinemia, diabetes mellitus, obesity and fibrinogen. Score of MRF was calculated as x/8. RESULTS: Out of total of 645 pts (10 yrs. follow-up) 399 pts (62%) had AOD, out of them single AOD had 295 pts (74%), and polyvascular disease 104 pts (26%). 63 (61%) pts of symptomatic group had combination of AOD + CAD, and 41 pts (39%) had AOD + CVD + CAD. In the pts with 8 yrs. follow-up (n-1035) AOD had 548 pts. (53%), single AOD had 334 pts (57%) and polyvascular had 122 pts (39%). Out of symptomatic pts. 71 (58.2%) had AOD + CAD, and 51 (41.8%) had AOD + CAD + CVD. Asymptomatic disease on the very entry period of the study was significant for both groups, p < 0.01. CONCLUSIONS: (i) we found a significant number of asymptomatic atherosclerotic changes on other vascular beds, (ii) score of MRF has correlated with polyvascular disease and with overall outcome (iii) antropomethric, haemodynamic, and morphological parameters of human blood vessels have been measured and systematically documented in Bosnia and Herzegovina.

[Arterial hypertension as a risk factor for multifocal atherosclerosis]. / Arterijska hipertenzija kao riziko-faktor za multifokalnu aterosklerotsku bolest.

BACKGROUND: It is well known that atherosclerosis as systemic disease have a significant correlation with score of multiple risk factors (MRF). Atherosclerosis as a multifocal disease, produces multisegmental stenotic changes of various arterial segments which arises simultaneously as a pre-existing asymptomatic disease. Aim of this study is to evaluate the presence of multifocal atherosclerotic disease among pts. with predominant arterial occlusive disease (AOD), and to correlate arterial hypertension as a major independent risk factor and multifocal atherosclerotic disease. METHODS: We included 109 consecutive patients treated at our Institute in the period Dec 1999--Dec 2000, all with clear arterial occlusive disease (AOD). According to Fontaine clinical staging of their AOD, we made three groups--group FII, clinical stage Fontaine II 63 pts, group FIII, clinical stage Fontaine III 32 pts, and group FIV, clinical stage Fontaine IV 14 pts. We evaluated clinical variables: age, gender, arterial hypertension (HTA), tobacco, hyperlipidemia (HLP), obesity (BMI), diabetes mellitus, coronary heart disease (CHD), and cerebrovascular disease (CVD). Score of MRF is calculated as x/9. Special focus has been made to pts. with positive HTA. All pts. were evaluated according to clinical evidence of CHD and CVD, respectively. RESULTS: We had 109 pts, 89 males and 20 females, average age of 62 yrs, males 63 and females 60 yrs. In the FII group were 63 pts. with average MRF 4.27, in the FIII group 32 pts. with MRF 3.97, in the FIV group 14 pts. with MRF 3.93. Out of the total number of pts. 52 were hypertensive (47.7%), 41 males, and 11 females, with average age 64.8 yrs, males, and 61.8 yrs, females. Isolated systolic HTA had 33 pts. (63.5%), and 19 pts. (36.5%) systolic and diastolic HTA. In whole group (n-109), multifocal disease, AOD + CHD, had 22 (20.21%) pts. (MRF score 4.86), AOD + CVD had (5.5%) 6 pts. (MRF score 3.66) and AOD + CHD + CVD had 8 (7.33%) patients (MRF score 6.13). In hypertensive pts. multifocal atherosclerotic disease, AOD + CHD, had 12 pts. (23.1%), and AOD + CHD + CVD, 2 pts (7.6%). Among clinical variables, tobacco was of high risk, 97 pts. positive (89.9%), what is of high significance, p < 0.001. CONCLUSIONS: We have a clear connection of multifocal disease with elevated MRF score, especially clinical variables, smoking (p < 0.001) and arterial hypertension (p < 0.01). Multifocal atherosclerotic disease was present in 36 pts. (33.1%), and among hypertensive pts. multifocal atherosclerotic disease was present in 14 pts. (26.9%). There is a high positive correlation rank of multifocal disease, HTA and score of MRF, r = .70, and borderline correlation rank of multifocal disease and score of MRF, r = .40.