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Relationship Between Risk Factors and Carotid Artery Stenosis Prevalence in Patients With Lower Extremity Peripheral Arterial Disease

Dedy Pratama, Haidir Bima, Aria Kekalih, Raden Suhartono

Introduction: One of degenerative disease is atherosclerosis. Peripheral artery disease (PAD) and carotid artery stenosis (CS) broadly covers vascular disease, both of which can be caused by atherosclerosis. Given the general etiology of peripheral atherosclerosis that can occur in different vascular locations, the presence of disease in one place increases the frequency of symptomatic and asymptomatic disease in another. Because both have the same cause, there is a hypothesis that the two are correlated. The purpose of this study was to determine the risk factors associated with carotid artery stenosis (CS) in patients with lower extremity peripheral artery disease (PAD) and to determine the prevalence of carotid artery stenosis (CS) and the thickness of intimal media thickness (IMT) in patients with lower extremity peripheral artery disease (PAD).

Method: This research was conducted at Cipto Mangunkusumo General Hospital during February-May 2018. This study was prospective. Data were taken from secondary data based on history and laboratory results, while the degree of stenosis and intimal media thickness were carried out by carotid duplex ultrasound (DUS) with united imaging ultrasound using a probe 8.5 Mhz. The receiver operating characteristic curve was used to assess the best cut point with sensitivity, specificity, positive predictive value, and negative predictive value.

Results: A total of 50 subjects with an age range between 49-80 years (63.8 ± 8.8 years), of which there were 31 male males (62%) and 19 females (38%). There was a correlation between hypercholesterolemia and smoking history with the degree of carotid stenosis (p <0.05), while risk factors for the degree of IMT was not found. The prevalence of mild carotid artery stenosis (CS) was 26 (52%), moderate carotid artery stenosis 15 (30%), severe carotid artery stenosis 9 (18%). In comparison, the IMT value in this study obtained 9 (18%) mild IMT, 22 (44%) moderate IMT, and 19 (38%) severe IMT.

Conclusion: In patients with severe PAD, the highest incidence of carotid artery stenosis (CS) was in the mild category (52%). The highest rate of intimal media thickness (IMT) was a medium-size IMT (44%). Carotid artery stenosis (CS) was associated with hypertension, diabetes, hypercholesterolemia, smoking, and a family history of atherosclerosis. In statistical analysis, hypercholesterolemia and smoking history had a relationship with the severity of carotid stenosis.

Keywords: Atherosclerosis, carotid artery stenosis (CS), carotid duplex ultrasound (DUS), intimal media thickness (IMT), peripheral arterial disease (PAD)

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