Spontaneous extracranial carotid atherosclerosis evolution in asymptomatic individuals: a three-year prospective study.
OBJECTIVE
To evaluate the spontaneous evolution of extracranial carotid atherosclerosis in asymptomatic patients who did not present the main risk factors associated to the disease.


METHODS
A prospective study including patients of both genders, age ranging from 40 to 70 years, not presenting any signs and symptoms of cerebrovascular disease and without the main atherosclerosis risk factors were included. Patients who were using or had used medication during the follow-up period that could potentially influence in the spontaneous course of atherosclerosis were excluded. The evaluation of the plaque and degree of stenosis were acquired using mode B, 7.5 MHz Doppler ultrasonography (USG). The follow-up was carried out for 36 months, with clinical, neurological, and USG exams repeated in a period of 6 to 8 months. Ninety-six individuals (48 women) completed the study with the presence of plaque, and 52 (26 women) with a degree of stenosis.


RESULTS
As to the degree of stenosis, 25% of the patients had worsening, 69% remained stable and 6% improved. When only the presence or absence of plaque was considered, 20% showed worsening (plaque developed during follow-up), 7% improved (disappearance of plaque), and 73% remained stable. No differences were found between the male and female patients.


CONCLUSIONS
These results confirm the dynamic characteristics of plaque. In asymptomatic individuals without specific treatment, spontaneous improvement may occur, however, rarely. These findings may contribute as an assessment criterion when a decision is to be made in high-risk patients.
Gagliardi
Rubens José
RJ
Cerebrovascular Diseases Division (Atherosclerosis League) of the Santa Casa de São Paulo-Faculty of Medical Sciences, São Paulo, SP, Brazil. rubensjg@apm.org.br
Damiani
Ibsen Thadeu
IT
Menoncello
Rogério
R
Ribeiro
Manoel Carlos Sampaio de Almeida
MC
D000328:Adult; D001161:Arteriosclerosis / Q000150:complications / Q000000981:diagnostic imaging*; D002342:Carotid Artery, External / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000209:etiology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D018608:Ultrasonography, Doppler