Carotid velocities determine cerebral blood flow deficits in elderly men with carotid stenosis <50%

Abstract

To examine if mild carotid stenosis correlates with silent vascular brain changes, we studied a prospective population-based cohort "Men born in 1914." Data from followups at ages 68 and 81, have been used. Carotid ultrasound was performed at age 81, and cerebral blood flow (CBF) was measured with SPECT at age 82. Out of 123 stroke-free patients, carotid stenosis <50% was observed in 94% in the right and 89% in the left internal carotid arteries (ICAs). In these subjects, Peak Systolic Velocities in ICA correlated negatively with CBF in a majority of several brain areas, especially in mesial temporal area. Results were limited to normotensive until their seventies, who developed late-onset hypertension with a subsequent blood pressure, pulse pressure, and ankle-brachial index growth. Elderly with asymptomatic carotid stenosis <50% and peak systolic velocities in ICA 0.7-1.3 m/s, should be offered an intensified pharmacotherapy to prevent stroke or silent cerebrovascular events.

Figure 1

Followup of the cohort “Men born in 1914.”

Figure 2

Distribution of regions of interest used for cerebral blood flow estimation. (f) Frontal; (tl) temporal lateral and (tm) temporal mesial; (pi) parietal inferior and (ps) parietal superior ROI; (bg) basal ganglia; (c) reference region in cerebellum.

Figure 3

Distribution of cerebral blood flow values (CBF), estimated in left mesial temporal area, depending on the level of peak systolic Velocity in left internal carotid artery (ICA). scatter presented for both normotensive and hypertensive subjects at age 68.