Prevalence of carotid stenosis and incidence of ischemic stroke in patients undergoing non-coronary cardiac surgery

Abstract Introduction: Many publications on coronary surgery and carotid stenosis (CS) can be found, but we do not have enough information about the relationship between ischemic stroke, CS and non-coronary cardiac surgery. Objectives: To evaluate the incidence and risk factors associated with the stroke and CS ≥50% in patients undergoing non-coronary surgeries. Objectives: We assessed 241 patients, aged 40 years or older, between 2009 and 2016, operated in Santa Casa de Misericórdia de Ponta Grossa-PR, Brazil. We perform carotid Doppler in patients 40 years of age or older before any cardiac surgery as a routine. The incidence and possible risk factors for CS ≥50% and perioperative stroke were analyzed by univariate statistical analysis. Results: 11 patients (4.56%) presented perioperative stroke. The risk factor for stroke was CS ≥50%: OR=5.3750 (1.2909-22.3805), P=0.0208. Eighteen patients (7.46%) had CS ≥50% and their risk factors were extracardiac arteriopathy: OR=18.6607 (6.3644-54.7143), P<0.0001; COPD: OR=3.9040 (1.4491-10.5179), P=0.0071; diabetes mellitus: OR=2.9844 (1.0453-8.5204), P=0.0411; recent myocardial infarction: OR=13.8125 (1.8239-104.6052), P=0.0110; EuroSCORE II higher P=0.0056. Conclusion: The incidences of stroke and CS ≥50% were 4.56% and 7.46%, respectively. The risk factor for stroke was CS ≥50% and for CS ≥50% were extracardiac arteriopathy, COPD, diabetes mellitus, recent myocardial infarction and higher EuroSCORE II.

Enfermedad carotídea aterosclerosa y enfermedad de sustancia blanca en sujetos sin historia de infarto cerebral o isquemia cerebral transitoria / Atherosclerotic Carotid Disease and White Matter Disease in Subjects Without a History of Cerebral Infarction or Transient Cerebral Ischemia

Resumen Introducción: La enfermedad carotídea aterosclerosa (ECA) es un factor de riesgo importante para enfermedad vascular cerebral. Objetivo: Analizar la asociación entre factores de riesgo vascular mayores con ECA y leucopatía cerebral en pacientes sin historia de ictus isquémico. Método: Se evaluaron factores de riesgo en sujetos con exploración de carótidas mediante ultrasonografía Doppler dúplex. No se incluyeron casos con historia de infarto cerebral o ataque isquémico transitorio. Los sujetos contaron con resonancia magnética cerebral y se excluyeron aquellos con lesiones isquémicas de grandes vasos. Se construyeron modelos multivariable para la predicción de ECA, estenosis carotídea significativa, carga de ateromas y leucopatía cerebral. Resultados: Se estudiaron 145 sujetos (60.7 % mujeres, edad de 73 años). Se documentó ECA en 54.5 %, estenosis carotídea ≥ 50 % en 9 %, carga de placas de ateroma > 6 en 7.6 % y leucopatía periventricular o subcortical en 28.3 % (20.6 % tenían concurrentemente ECA y leucopatía). Los factores asociados independientemente con ECA fueron edad e hipertensión; con estenosis ≥ 50 %, hipertensión; con cargas de ateromas > 6 placas, edad; con leucopatía, edad, diabetes e hipertensión. La obesidad no se asoció con las variables independientes analizadas. Conclusiones: En los sujetos asintomáticos sin historia de ictus isquémico, la edad y la hipertensión fueron los factores de riesgo más importantes para enfermedad macrovascular. La diabetes mellitus se asoció con enfermedad microvascular. La obesidad por sí sola no fue un determinante mayor de ECA o leucopatía cerebral.

Abstract Introduction: Atherosclerotic carotid artery disease (CAD) is a major risk factor for cerebrovascular disease. Objective: To analyze the association of major vascular risk factors with atherosclerotic CAD and white matter disease (WMD) in patients without a history of ischemic stroke. Method: Risk factors were assessed with carotid examination using Doppler duplex ultrasound. Cases with a history cerebral infarction or transient ischemic attack were not included. Subjects had brain magnetic resonance imaging scans available and those with large-artery ischemic lesions were excluded. Multivariate models were constructed for the prediction of atherosclerotic CAD, significant carotid stenosis, atheroma burden and WMD. Results: One-hundred and forty-five subjects were assessed (60.7% were females, mean age was 73 years). Atherosclerotic CAD was documented in 54.5%, carotid stenosis ≥ 50% in 9.0%, > 6 atheroma plaques in 7.6%, and periventricular or subcortical WMD in 28.3% (20.6% had atherosclerotic CAD and WMD concurrently). Risk factors independently associated with atherosclerotic CAD were age and hypertension; hypertension was associated with ≥ 50% carotid stenosis; age was associated with > 6 atheroma plaques; and age, diabetes and hypertension were associated with WMD. Obesity was not associated with any of the analyzed independent variables. Conclusions: In asymptomatic subjects without a history of ischemic stroke, age and hypertension were the most important risk factors for macrovascular disease. Diabetes mellitus was associated with microvascular disease. Obesity alone was not a major determinant of CAD or WMD.

A workshop on asthma management programs and centers in Brazil: reviewing and explaining concepts / Programas e centros de atenção a asmáticos no Brasil; uma oficina de trabalho: revisitando e explicitando conceitos

Objective: To report the results of a workshop regarding asthma management programs and centers (AMPCs) in Brazil, so that they can be used as a tool for the improvement and advancement of current and future AMPCs. Methods: The workshop consisted of five presentations and the corresponding group discussions. The working groups discussed the following themes: implementation of asthma management strategies; human resources needed for AMPCs; financial resources needed for AMPCs; and operational maintenance of AMPCs. Results: The workshop involved 39 participants, from all regions of the country, representing associations of asthma patients (n = 3), universities (n = 7), and AMPCs (n = 29). We found a direct relationship between a lack of planning and the failure of AMPCs. Based on the experiences reported during the workshop, the common assumptions about AMPCs in Brazil were the importance of raising awareness of managers; greater community participation; interdependence between primary care and specialized care; awareness of regionalization; and use of medications available in the public health system. Conclusions: Brazil already has a core of experience in the area of asthma management programs. The implementation of strategies for the management of chronic respiratory disease and their incorporation into health care system protocols would seem to be a natural progression. However, there is minimal experience in this area. Joint efforts by individuals with expertise in AMPCs could promote the implementation of asthma management strategies, thus speeding the creation of treatment networks, which might have a multiplier effect, precluding the need for isolated centers to start from zero. .

Objetivo: Relatar os resultados de uma oficina de trabalho sobre programas e centros de atenção a asmáticos (PCAAs) no Brasil para que possam servir como instrumento para melhoria e avanço dos PCAAs existentes e criação de novos. Métodos: A oficina de trabalho constituiu-se de cinco apresentações e discussões em grupos. Os grupos de trabalho discutiram os seguintes temas: implementação de uma linha de cuidado em asma; recursos humanos necessários para os PCAA; recursos necessários para financiar os PCAA; e manutenção do funcionamento dos PCAAs. Resultados: A oficina envolveu 39 participantes de todas as regiões do país, representando associações de asmáticos (n = 3), centros universitários (n = 7) e PCAAs (n = 29). Evidenciou-se uma relação direta entre a ausência de planejamento e o insucesso dos PCAAs. Com base nas experiências brasileiras elencadas durante a oficina, as premissas comuns foram a importância da sensibilização do gestor, maior participação da comunidade, interdependência entre a atenção primária e a especializada, observação da regionalização e utilização dos medicamentos disponíveis no sistema público de saúde. Conclusões: O Brasil já tem um núcleo de experiências na área programática da asma. A implementação de uma linha de cuidado em doenças respiratórias crônicas e sua inclusão nas redes de saúde parecem ser o caminho natural. Porém, a experiência nessa área ainda é pequena. Agregar pessoas com experiência nos PCAAs na elaboração da linha de cuidado em asma encurtaria tempo na criação de redes de atenção com possível efeito multiplicador, evitando que se partisse do zero em cada local isolado. .

Carotid stenosis: what is the high-risk population?

OBJECTIVE: Prevention is the best treatment for cerebrovascular disease, which is why early diagnosis and the immediate treatment of carotid stenosis contribute significantly to reducing the incidence of stroke. Given its silent nature, 80% of stroke cases occur in asymptomatic individuals, emphasizing the importance of screening individuals with carotid stenosis and identifying high-risk groups for the disease. The aim of this study was to determine the prevalence and the most frequent risk factors for carotid stenosis. METHODS: A transversal study was conducted in the form of a stroke prevention campaign held on three nonconsecutive Saturdays. During the sessions, carotid stenosis diagnostic procedures were performed for 500 individuals aged 60 years or older who had systemic arterial hypertension and/or diabetes mellitus and/or coronary heart disease and/or a family history of stroke. RESULTS: The prevalence of carotid stenosis in the population studied was 7.4%, and the most frequent risk factors identified were mean age of 70 years, carotid bruit, peripheral obstructive arterial disease, coronary insufficiency and smoking. Independent predictive factors of carotid stenosis include the presence of carotid bruit or peripheral obstructive heart disease and/or coronary insufficiency. CONCLUSIONS: The population with peripheral obstructive heart disease and carotid bruit should undergo routine screening for carotid stenosis.

Estenose carotídea e cirurgia de revascularização miocárdica / Carotid stenosis and coronary artery bypass grafting

OBJETIVO: Identificar a prevalência de estenose carotídea (EC) e os possíveis preditores de mortalidade em indivíduos submetidos à cirurgia de revascularização miocárdica (CRM) eletiva. MÉTODOS: Estudo de coorte que incluiu 393 candidatos à CRM. Todos os pacientes realizaram ultrassonografia com Doppler em cores de artérias carótidas antes da CRM e foram seguidos durante a internação quanto à morbidade e mortalidade. A EC foi considerada clinicamente relevante quando > 50 por cento. Um p < 0,05 foi considerado significativo. Regressão logística foi realizada para definir preditores independentes de mortalidade. RESULTADOS: A prevalência de EC foi de 17,4 por cento. Após regressão logística, EC > 50 por cento (p = 0,001) e insuficiência renal crônica (IRC) (p = 0,03) foram preditores, independentes de mortalidade. CONCLUSÃO: EC mostrou ter uma prevalência elevada na amostra estudada e, conjuntamente com a IRC, foi preditor, independente de mortalidade.

OBJECTIVE: To identify carotid stenosis (CS) prevalence and potential mortality predictors in individuals undergoing elective coronary artery bypass grafting (CABG). METHODS: Cohort study including 393 scheduled for CABG. All patients underwent a color Doppler ultrasound study of the carotid arteries prior to CABG and were assessed for morbidity and mortality over the hospitalization. CS was considered clinically relevant when if > 50 percent. Significance was set at p < 0.05. Logistic regression was used to define mortality independent predictors. RESULTS: CS prevalence was 17.4 percent. Following logistic regression analysis, CS > 50 percent (p = 0.001) and chronic renal failure (CRF) (p = 0.03) remained as mortality independent predictors. CONCLUSION: CS showed a high prevalence in the study sample and together with CRF was a mortality independent factor.

Prevalência de estenose carotídea em pacientes com indicação de cirurgia de revascularização miocárdica / Prevalencia de estenosis carotidea en pacientes con indicación de cirugía de revascularización miocárdica / Prevalence of carotid stenosis in patients referred to myocardial revascularization surgery

FUNDAMENTO: Embora a aterosclerose carotídea seja a principal causa de acidente vascular cerebral, a prevalência de estenose clinicamente significativa (>50 por cento) permanece desconhecida em nosso meio, principalmente em indivíduos com indicação de cirurgia eletiva de revascularização do miocárdio. OBJETIVO: Identificar a prevalência e o grau de estenose carotídea em indivíduos com indicação de cirurgia de revascularização miocárdica em um centro de referência em cardiologia no Brasil. MÉTODOS: Estudo transversal no qual 457 pacientes consecutivos e de ambos os gêneros foram avaliados, entre maio de 2007 e abril de 2008, através de ultrassonografia com Doppler em cores de artérias carótidas, no pré-operatório de cirurgia de revascularização miocárdica eletiva. Para a análise estatística foi usado o programa SPSS 10.1. Um valor-p<0,05 foi considerado significativo. Houve perda de 7 pacientes no decorrer do estudo. RESULTADOS: A média de idade (±desvio padrão) foi de 62,2 ± 9,4 anos sendo que 65,6 por cento eram do gênero masculino. A prevalência de estenose carotídea significativa foi de 18,7 por cento. Quanto à estratificação do grau de estenose carotídea: ausência de estenose ocorreu em 3,6 por cento, estenose inferior a 50 por cento, em 77,8 por cento, estenose entre 50 por cento e 69 por cento em 11,6 por cento, estenose entre 70 por cento e 99 por cento em 6,9 por cento e oclusão da artéria em 0,2 por cento. A sensibilidade e especificidade em relação ao sopro carotídeo foram, respectivamente, 34,5 por cento e 88,8 por cento. CONCLUSÃO: A prevalência de estenose carotídea significativa foi alta na amostra estudada, sugerindo tratar-se de população de alto risco para acidente vascular cerebral.

BACKGROUND: Although the carotid stenosis is the main cause of cerebrovascular accident, the prevalence of clinically significant stenosis (>50 percent) remains unknown in our country, mainly in individuals with a surgical indication for elective myocardial revascularization surgery. OBJECTIVE: To identify the prevalence and degree of carotid stenosis in individuals with a surgical indication for MRS in a reference center in Cardiology in Brazil. METHODS: Transversal study of 457 consecutive patients of both genders, evaluated between May 2007 and April 2008 through ultrasonography with color Doppler of the carotid arteries, during the preoperative period of elective MRS. The statistical analysis was performed with the SPSS program, version 10.1. A p value <0.05 was considered significant. Seven patients were lost throughout the study. RESULTS: The mean age (±standard deviation) was 62.2 ± 9.4 years and 65.6 percent of the patients were males. The prevalence of significant carotid stenosis was 18.7 percent. As for the stratification of the degree of carotid stenosis: absence of stenosis was observed in 3.6 percent; stenosis < 50 percent was observed in 77.8 percent; stenosis between 50 percent and 69 percent was observed in 11.6 percent; stenosis between 70 percent and 99 percent was observed in 6.9 percent and arterial occlusion was observed in 0.2 percent of the individuals. The sensitivity and specificity regarding the carotid bruit were 34.5 percent and 88.8 percent, respectively. CONCLUSION: The prevalence of significant carotid stenosis was high in the studied sample, which suggests this is a high-risk population for the occurrence of cerebrovascular accident.

FUNDAMENTO: Aún cuando la aterosclerosis carotidea es la principal causa de accidente cerebrovascular, la prevalencia de estenosis clínicamente significativa (>50 por ciento) permanece desconocida en nuestro medio, principalmente en individuos con indicación de cirugía electiva de revascularización de miocardio. OBJETIVO: Identificar la prevalencia y el grado de estenosis carotidea en individuos con indicación de cirugía de revascularización miocárdica, en un centro de referencia en cardiología en Brasil. MÉTODOS: Estudio transversal, en el que fueron evaluados 457 pacientes consecutivos y de ambos géneros, entre mayo de 2007 y abril de 2008, mediante ecografía Doppler color de arterias carótidas, en el preoperatorio de cirugía de revascularización miocárdica electiva. Para el análisis estadístico se utilizó el programa SPSS 10.1. Un valor-p<0,05 fue considerado significativo. En el transcurso del estudio se perdió 7 pacientes. RESULTADOS: El promedio de edad (desviación estándar) fue de 62,2 ± 9,4 años y el 65,6 por ciento era de género masculino. La prevalencia de estenosis carotidea significativa fue de 18,7 por ciento. En cuanto a la estratificación del grado de estenosis carotidea: ausencia de estenosis en un 3,6 por ciento, estenosis inferior al 50 por ciento, en un 77,8 por ciento, estenosis entre el 50 por ciento y el 69 por ciento en un 11,6 por ciento, estenosis entre el 70 por ciento y el 99 por ciento en un 6,9 por ciento y oclusión de la arteria en un 0,2 por ciento de los pacientes. La sensibilidad y especificidad en relación al soplo carotideo fueron, respectivamente, del 34,5 por ciento y del 88,8 por ciento. CONCLUSIÓN: La prevalencia de estenosis carotidea significativa fue alta en la muestra estudiada, lo cual sugiere que se trata de población de alto riesgo para accidente cerebrovascular.

Estudio con ultrasonido doppler color en la caracterización de la enfermedad aterosclerotica carotidea oclusiva sintomática / Study with color doppler ultrasound in the characterization of symptomatic carotid atherosclerotic occlusive disease

Objective: To determine the association between risk factors and atherosclerosis in the carotid arteries in occlusive cerebrovascular disease. Method: A prospective, descriptive, cross-sectional study in 274 patients with clinical and CT diagnosis ofischemic ictus was conducted. Examination by the means of carotid artery color Doppler ultrasound was performed in the study Group. Results and Conclusions: The mean age of patients was 68.7 years anda male predominance (54.1 percent) was reported. Arterial hypertension, which was present in 214 patients (78.1 percent), constituted the most prevalent atherogenic risk factor, followed by age over 60 years (75.9 percent), and smoking (58 percent). The atherothrombotic and cardioembolic origins were predominant (54 percent and 19.7 percent, respectively), followed by lacunar (13.9 percent), and undetermined origin (11.3 percent). Atherosclerotic involvement occurs bilaterally with a predominance of the right axis, appearing low shear stress areas as the sites of the greatest severity.

Objetivo: Determinar la asociación entre los factores de riesgos y la aterosclerosis de las arterias carótidas, en la enfermedad cerebrovascular oclusiva. Método: Se realizó un estudio prospectivo, descriptivo y transversal en 274 pacientes con diagnóstico clínico y tomográfico de ictus isquémico, realizándoles estudio con ultrasonido Doppler color carotídeo. Resultados y Conclusiones: La edad media de los pacientes fue 68,7años. Se observó predominio de sexo masculino (54,1 por ciento). EI factor de riesgo aterogénico que predominó fue HTA, presente en 214 (78.1 por ciento), seguido por edad mayor de 60 (75.9 por ciento) y tabaquismo (58 por ciento). El origen aterotrombótico y cardioembólico fueron predominantes (54 y 19.7 por ciento respectivamente), seguidos por el lacunar (13.9 por ciento) y el origen indeterminado (11.3 por ciento). La afectación aterosclerótica ocurre bilateralmente, con un predominio del eje derecho, siendo las zonas de bajo shear stress los sectores de mayor severidad.

Prevalence of carotid and renal artery stenosis in patients with significant coronary artery disease

Atherosclerosis as a vascular disease can involve any artery in the body including large and medium sized arteries. Only a few angiographic studies have correlated the presence and severity of coronary artery disease with atherosclerosis in other arteries. The aim of this study is to evaluate the prevalence of the carotid and renal artery stenosis in patients with documented coronary artery disease and the role of predisposing risk factors for such affection in Egyptian patients. This study included 100 patients with documented significant coronary artery disease. All were subjected to carotid and renal angiography. They were divided into: group I which included patients with significant carotid artery stenosis [>50%] either unilateral or bilateral, and group II which included patients with normal carotid. They divided again into: group A which included patients with significant renal artery stenosis [>50%], while group B included patients with normal renal angiography. For all patients, random blood sugar, serum urea, creatinine and complete lipid profile was assessed. Group I included 17 patients while Group II included 83 patients with documented significant coronary artery disease. There were significant correlations between either of age, hypertension, dyslipedemia, diabetes mellitus and presence of carotid artery stenosis. While there was no relation between carotid artery stenosis with neither gender nor smoking. Number of the affected coronary arteries was the significant multivariate predictor of significant carotid artery stenosis. While group A included 7 patients and group B included 93 patients with documented coronary artery disease. Hypertension and serum levels of both urea and creatinine were significantly univariate predictor of the presence of renal artery stenosis. The significant multivariate predictor of presence of renal artery stenosis was serum level of blood urea. The prevalence of significant carotid artery stenosis with significant coronary artery disease was found to be 17%. The prevalence of significant renal artery stenosis with significant coronary artery disease was found to be 7%. Carotid artery disease is more common in patients with old age, hypertension, dyslipidemia and with more than two vessel diseased coronaries. Renal artery disease is more common in hypertensive patients with elevated blood urea and serum creatinine levels and with more than two vessel diseased coronaries

Carotid artery stenting prior to coronary artery bypass graft surgery inpatients with left-main-coronary-artery disease.

Patients with concomitant carotid and left main or left main equivalent coronary artery disease are at high risk of both cardiac and cerebrovascular complications when they undergo revascularization procedures. Here, we present case reports of three patients who successfully underwent elective carotid stenting prior to coronary artery bypass surgery. Any sort of intervention in these patients is fraught with high risk due to the severity of their carotid and coronary artery disease.

Estenose carotídea acima de 70 por cento em pacientes no pré-operatório de cirurgia da aorta abdominal: freqüência e fatores de risco / Frequency and risk factors for carotid stenosis above 70 percent in patients undergoing abdominal aortic surgery

OBJETIVO: Analisar a freqüência e os fatores de risco associados à estenose carotídea acima de 70 por cento em pacientes que serão submetidos a cirurgias de aorta abdominal. MATERIAL E MÉTODO: Foram analisados 94 pacientes que realizaram ultra-som Doppler de carótidas no pré-operatório de cirurgias de aorta abdominal entre janeiro de 2000 e janeiro de 2003, pela disciplina de Cirurgia Vascular da Santa Casa de São Paulo. RESULTADOS: Sessenta e sete pacientes (71 por cento) eram homens. Dentre os 94 pacientes, 42 (44,6 por cento) tinham doença oclusiva aorto-ilíaca, e 52 (53,4 por cento), aneurismas da aorta abdominal (AAA). A análise dos dados mostrou uma prevalência de estenose de carótidas acima de 70 por cento em 8,33 por cento dos pacientes com AAA e em 13,51 por cento dos pacientes com doença oclusiva aorto-ilíaca, diferença esta sem significância estatística (P = 0,5). Nos pacientes que apresentavam antecedente de isquemia cerebral - acidente vascular cerebral (AVC) ou ataque isquêmico transitório (AIT) -, houve uma prevalência estatisticamente maior de estenose carotídea entre 70 e 99 por cento. Outros fatores de risco para aterosclerose, como sexo masculino, diabetes, hipertensão arterial e tabagismo, não foram preditivos da presença de estenose carotídea acima de 70 por cento. CONCLUSÃO: A freqüência de estenose da carótida acima de 70 por cento em pacientes no pré-operatório de cirurgia de aorta foi de 9,57 por cento, e a presença de antecedente de AVC ou AIT na história foi preditiva de estenose acima de 70 por cento neste grupo de pacientes.

Prevalencia de la ateromatosis carotídea en pacientes con enfermedad cerebro vascular oclusiva / Prevalence of carotid atherosclerosis among patients with ischemic stroke

Background: Hispanics have a greater incidence of stroke and prevalence of intracranial atherosclerosis than whites. Aim: To study the prevalence of extracranial atherosclerosis among patients admitted to a hospital with an ischemic stroke. Material and methods : A prospective study in stroke patients admitted to a Neurology ward in a University Hospital. All were subjected to a CT scan, carotid duplex-Doppler ultrasonographic examination with Doppler measurement of blood flow velocity, permeability and plaques. Cardiac emboli were searched with transthoracic and transesophagic echocardiography. Results: One hundred ten patients (39 women), aged 67.5ñ11.4 years old were studied. Stroke was atherothrombotic in 46 (41.8 percent), embolic in 30 (27.3 percent), lacunar in 27 (24.6 percent) and of other type in 7 (6.4 percent). Ninety two patients (84.4 percent) had high blood pressure, 38 percent had high cholesterol levels, 35 percent had a cardiac disease and 26 percent were smokers. Thirty five subjects (31.8 percent) had a normal carotid ultrasonography, 46 (41.8 percent) had mural plaques, 16 (14.5 percent) had multiple plaques without occlusion, 13 (11.8 percent) had a partial occlusion and 7 (6,4 percent) had a total occlusion. Logistic regression analysis disclosed no significant relationship between stroke types and carotid atherosclerosis. Age was the only significant predictor for carotid atherosclerosis. Conclusions: The prevalence of severe carotid atherosclerosis in this group of stroke patients was less than expected

Prevalencia de aterosclerosis carotídea en una población de la ciudad de México / Prevalance of carotid atherosclerosis in a cohort of Mexico City

Para conocer la prevalencia de aterosclerosis en personas mayores de 60 años, se realizó ultrasonografía de alta resolución y Doppler con imagen de flujo codificada a color, de las arterias carótidas a participantes del proyecto CUPA (estudio de vigilancia epidemiológica iniciado en 1989 en el Distrito Federal). En cada participante se evaluó la presencia de las siguientes lesiones ateroscleróticas: 1) engrosamiento de la última y la media; 2) acodamientos y tortuosidades; 3) placas de ateroma no estenosantes y 4) estenosis carotídea significativa (50 por ciento). El análisis de 198 estudios llevados a cabo en 56 hombres y 142 mujeres mostró que 130 personas presentaron alguna de las lesiones investigadas (65.6 por ciento) y que su frecuencia aumenta con la edad, de tal forma que en menores de 65 años fue de 38 por ciento, en los sujetos de 65 a 74 años de 71 por ciento y en mayores de 75 años de 88 por ciento. La frecuencias de lesiones estenóticas avanzadas fue más bien baja (6 por ciento), mientras que la frecuencia global de las placas de ateroma no estenosante y el engrosamiento de la íntima y la media fue mayor del 60 por ciento. Este último fue mas usual en hombres, mientras que las placas no estenosantes y la estenosis de mayor grado, se observaron con más frecuencia en las mujeres. Sin embargo, no hubo diferencias significativas entre hombres y mujeres al analizarse las lesiones por grupos de edad. Es el primer estudio sobre la prevalencia de aterosclerosis carotídea en México basado en evaluación ultrasonográfica. Los hallazgos de la investigación documentan una elevada frecuencia de ateroclerosis entre residentes de 60 años de la ciudad de México