Prevalence and outcome of symptomatic carotid lesions in young adults. National Research Council Study Group.
OBJECTIVE
To estimate the prevalence and outcome of symptomatic internal carotid artery lesions in young adults.


METHODS
Multicentre hospital based observational study with five year follow up.


METHODS
Seven neurological departments in northern and central Italy.


METHODS
240 patients (115 men) aged 15-44 with a recent transient ischaemic attack or stroke in the carotid territory.


METHODS
(a) Prevalence of symptomatic internal carotid artery stenosis or occlusion detected by continuous wave Doppler ultrasonography at entry; (b) incidence rates of cerebral, cardiac, and non-vascular death; non-fatal stroke; and non-fatal myocardial infarction.


RESULTS
Carotid stenoses of 50-99% and occlusions were found in 38 patients (15.8%). Both conditions were significantly more frequent in patients aged over 35 and in those with hypertension, diabetes mellitus, and stroke at entry. The standardised mortality ratio at five years was 10.5 (95% confidence interval 5.0 to 19.3). Survival of patients with stenoses of 0-49% and occlusions was significantly better than that of patients with stenoses of 50-99%. Carotid stenosis of 50-99% was an independent predictor of death (hazard ratio 7.9; 95% confidence interval 2.2 to 29) and non-fatal stroke (hazard ratio 7.4; 1.5 to 37.4).


CONCLUSIONS
The prevalence of carotid stenosis or occlusion in young adults after a cerebrovascular event is low. Though patients with high grade symptomatic carotid stenosis are at risk of non-fetal and fetal events, patients with internal artery occlusion apparently have a benign prognosis.
Carolei
A
A
Dipartimento di Medicina, Interna e Sanità Pubblica, Università degli Studi di L'Aquila, Ospedale, S Maria di Collemaggio, Italy.
Marini
C
C
Nencini
P
P
Gandolfo
C
C
Motto
C
C
Zanette
E
E
Prencipe
M
M
Fieschi
C
C
D000293:Adolescent; D000328:Adult; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D002561:Cerebrovascular Disorders / Q000150:complications / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012307:Risk Factors; D015996:Survival Rate; D018608:Ultrasonography, Doppler