Key result
Asymptomatic carotid stenosis over 50% affects ~22% of patients with peripheral arterial disease.
Why the study?
Identifying patients with asymptomatic extracranial carotid disease before cerebral ischemia is important due to high ischemic stroke mortality and recurrence rates.
What is the prevalence of moderate and severe asymptomatic extracranial carotid disease in patients with peripheral artery disease?
Meta-Analysis (n=114,514)
What is the prevalence of moderate and severe asymptomatic extracranial carotid disease in patients with peripheral artery disease?
There is a high prevalence (22%) of moderate to severe asymptomatic extracranial carotid disease in patients with peripheral artery disease, suggesting a potential need for screening in this high-risk population.
Answers are grounded in this paper and cite their sources.
22% AECD prevalence in PAD supports targeted carotid screening; extends multisite atherosclerosis data but leaves optimal strategies open.
INTRODUCTION: Cerebrovascular accidents are the third biggest cause of death in the West. Ischemic stroke mortality may reach 33% with a 20% recurrence rate in the first year. Thus, identifying patients with asymptomatic extracranial carotid disease (AECD) before cerebral ischemia is of great importance to public health concerns. The paper presents a systematic review and meta-analysis of AECD occurrence in peripheral arterial disease (PAD) patients.EVIDENCE ACQUISITION: A systematic review following designated protocols from “Preferred Reporting Items for Systematic reviews and Meta-analysis” (PRISMA), encompassing research in the PubMed, Medline, Cochrane and Embase data banks. A rigorous evaluation process was concluded with the outcome being the presence of AECD on more than 50% of PAD patients. Nine studies with a total of 114,514 patients were included: 3 prospective studies, 4 retrospective studies, 2 transversal studies were selected for meta-analysis. The stenosis proportion higher than 50% AECD was of 22% with a 95% confidence interval between 16% and 29%; however, its heterogeneity was of I2=98%. Symmetry was identified on funnel plot studies.EVIDENCE SYNTHESIS: The systematic review spanning the last 13 years and the meta-analysis have shown a prevalence of 22% AECD>50% in patients with PAD, leading to reasonable concern over AECD in PAD patients.CONCLUSIONS: However, the heterogeneity within the studies was elevated, probably due to differences in carotid stenosis ultrasound diagnosis procedures among one another.
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Manzioni et al. (2023) conducted a meta-analysis in Peripheral arterial disease (n=114,514). Peripheral arterial disease was evaluated on Prevalence of asymptomatic extracranial carotid disease (AECD) >50% stenosis (95% CI 16-29). In patients with peripheral arterial disease, the pooled prevalence of asymptomatic extracranial carotid disease with >50% stenosis was 22%.
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