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HERDIN Record #: PCHRD072009120736 Submitted: 21 July 2009 Modified: 18 July 2012

Natural history of patients with 50-69 percent internal carotid artery stenosis: A Philippine Heart Center experience.

Melissa Bernardo,
Kathleen G. Go

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This study aims to determine the natural history of patients with natural history of patients with 50-69 percent with internal carotid artery stenosis according to plaque morphology in previously symtopmatic and asymptomatic patients.

Methods and Results
This is a retro-prospective cohort study involving 73 patients with 50-69 percent internal carotid artery stenosis seen at the Philippine Heart Center - Vascular Laboratory from January 1, 2004 to June 30, 2006 with average follow-up of 18 months. All eligible patients were entered into a protocol of carotid duplex scan surveillance and clinical examination. All patients were scheduled for follow-up and repeat duplex ultrasound scan with a minimum of 6 months since the baseline carotid duplex imaging. Mean age was 73 + 8.86 years and 69 + 9.04 years for the symptomatic and asymptomatic groups. Majority of the patients were hypertensive for both groups. Male gender, smoking history, diabetes mellitus, coronary artery disease and dyslipidemia failed to show any statistically significant difference between the two groups. Majority of the group had calcified or type V plaque morphology, 70.7 percent and 65.6 percent for the symptomatic and asymptomatic group, respectively. Ipsilateral stroke occurred in 2 (4.9 percent) among the symptomatic group, both having type V plaques while 2 (6.25 percent) among the asymptomatic group, one with type III and the other one with type V plaques. There were more patients who had ipsilateral transient iscnemic attacks, 9 (22 percent) for the symptomatic group compared to 4 (12.5 percent) for the asymptomatic group with mostly type V plaques. Overall, there were more new neurologic events for patients who were symptomatic at baseline with type V plaque morphology but it was not statistically significant. Among the 73 patients included in the study, only 15 patients had repeat carotid duplex scan done. Eight were symptomatic while 7 were asymptomatic at baseline. Forty percent (6 out of 15) showed progression of the stenosis of equal to or more than 70 percent over a mean period of 18 months. One patient with symptomatic type V plaque had another episode of ipsilateral stroke, 1 patient with symptomatic type II plaque and 1 patient with asymptomatic type V plaque had episodes of ipsilateral TIA.

Conclusion -- In this study, the plaque morphology of patients with 50-69 percent internal carotid artery stenosis failed to show any correlation with the different predisposing factors other than age and hypertension. Symptomatic and asymptomatic status also failed to correlate statistically with the plaque morphology, and incidence of ipsilateral stroke, TIA and total neurological events.

Publication Type
Publication Sub Type
Philippine Heart Center Journal
Publication Date
January-March 2007


General Objectives: To determine the natural history of 50-69 percent carotid artery stenosis according to ultrasonic plaque morphology.

Specific Objectives:

1. To determine the clinical and demographic characteristics of patients included in the study in terms of the following data:
a Age
b. Sex
c. Predisposing factors
i. Smoking
ii. Hypercholesterolemia
iii. Hypertension
iv. Coronary artery disease
v. Diabetes mellitus

2. To determine the proportion of patients who are symptomatic and asymptomatic.

3. To determine proportion of patients who will develop ipsilateral strokes or TIA based on plaque morphology.

4. To determine the proportion of patients that will progress to >70 percent stenosis or occlusion based on plaque morphology.

5. To determine whether progression of stenosis is related to development of symptoms based on plaque morphology.

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