The stenotic carotid artery plaque : prevalence, risk factors and relations to clinical disease : the Tromsø study

Abstract

Stroke is the second leading cause of death in the world and is responsible for a high percentage of major disability, requiring substantial resources spent on care and rehabilitation. Atherosclerosis due to lipid accumulation in the vessel wall with formation of stenotic atheromatous plaques in the carotid bifurcation and/or the internal carotid artery is an important cause of stroke. In 1991, two large, multi-center trials reported that carotid endarterectomy was of benefit to patients with a degree of stenosis above 70%, and thus showed that the degree of stenosis was a major risk factor for ipsilateral stroke. However, it is well known that many high-grade stenoses remain stable and never cause cerebrovascular events, while others develop rapidly and produce serious, potentially life-threatening disease. While the majority of patients presenting with transient ischemic attack (TIA) and stroke has an ipsilateral carotid lesion, only about half of them have a hemodynamically significant carotid stenosis. Only 5-15% of strokes are heralded by a TIA. This has led to a search for additional risk factors which might help identify the individuals with a high risk for stroke.