Incidence, Risk Factor and Prognosis of Carotid Artery Stenosis in Patients with Atherosclerotic Occlusive Disease

Objective: To study the incidence and risk factors of carotid artery stenosis (CAS) in patients with lower extremity arteriosclerosis obliterans (ASO), and divide them into different subgroups according to symptomatic and asymptomatic carotid artery stenosis and different stenosis degrees, and study the limb prognosis and nervous system prognosis of patients respectively. Methods: This study is a single-center retrospective study. We collected the clinical data of 400 patients diagnosed with lower extremity arteriosclerosis occlusive disease and completed carotid artery ultrasound. All Patients were from the vascular surgery Department of the First Affiliated Hospital of Chongqing Medical University from June 2020 to June 2022. The result shows that 102 patients with significant carotid artery stenosis, 298 patients with non-significant carotid artery stenosis or without carotid artery stenosis. The clinical characteristics, laboratory tests, characteristics of ASO of the two groups were analyzed. Risk factors were studied through multiple logistics regression analysis. Patients were divided into 2 subgroups according to whether they were symptomatic carotid artery stenosis and different degrees of CAS. Then their limb outcomes (including ischemia exacerbation, amputation rate) and nervous system outcomes (incidence of ischemic stroke) were studied respectively. Results: Of 400 patients with ASO, 102(25.5%) had >50% carotid stenosis. Smoking, dyslipidemia (including the increase of total cholesterol level, triglyceride level), ankle-brachial index (ABI) <0.5, <0.3 were the risk factors. Meanwhile, taking statins can significantly reduce the incidence of carotid artery stenosis, which is a protective factor. In the neurological outcomes of patients, the adverse prognosis of symptomatic carotid artery stenosis increased significantly, and the difference was statistically significant. With the aggravation of the degree of carotid artery stenosis, the incidence of adverse prognosis of nervous system also increased gradually, the difference was statistically significant. Among limb outcomes, non-surgical patients with moderate carotid stenosis were more likely to have poor limb outcomes. Conclusion: In clinical work, carotid ultrasound can be routinely screened for patients with the above risk factors, and carotid follow-up should be strengthened for patients with significant carotid artery stenosis, revascularization should also be encouraged to achieve better neurological and limb prognosis.