Stenotic occlusive lesions of internal carotid artery in diabetic patients

Vidjak, Vinko and Hebrang, Andrija and Brkljačić, Boris and Barada, Ante and Brajša, Mladen and Brnić, Zoran and Novačić, Karlo and Grga, Ante and Hlevnjak, Dubravko and Flegar-Meštrić, Zlata and Vrhovski-Hebrang, Danijela (2007) Stenotic occlusive lesions of internal carotid artery in diabetic patients. Collegium Antropologicum, 31 (3). pp. 775-780. ISSN 0350-6134

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Abstract

Diabetes deteriorates atherosclerotic changes in the arteries. The aim of the study was to assess the prevalence and localization of stenotic atherosclerotic lesions of the internal carotid artery (ICA) in patients with diabetes. A prospective analysis of angiography findings was carried out in 150 diabetic and 150 non-diabetic patients with symptoms of cerebral ischemia using double-blind angiogram readings by two independent investigators. The degree of stenosis was determined using the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria. Stenoses of the proximal arterial segment accounted for the majority of extracranial ICA stenoses, being more frequent in diabetic (left ICA 50.7%, right ICA 58.0%) than in the non-diabetic patients (left ICA 29.3%, right ICA 32.7%). Diabetic patients revealed a more significant rate of unilateral tandem ICA stenoses (14.0-21.3%), as well as a statistically significantly higher prevalence of intracranial ICA stenoses (left ICA 24.0% and right ICA 17.3%) than did non-diabetic patients (left and right ICA 3.3% each). Our results confirm that there is a morphological basis in ICA for increased incidence of ICA lesions in patients with diabetes as compared to those without it. Data on the incidence of stenotic ICA lesions in diabetes suggest the importance of assessing overall ICA status using digital subtraction angiography. Such an assessment is a precondition for an optimal therapeutic approach, especially in diabetic patients who are at an increased risk of cerebrovascular disease.

Abstract in Croatian

Šećerna bolest doprinosi razvoju aterosklerotskih promjena na arterijama. Cilj istraživanja bio je odrediti učestalost i lokalizaciju stenotičnih aterosklerotskih promjena unutarnje karotidne arterije (ACI) u dijabetičkih bolesnika. Metodom dvostrukog slijepog očitavanja angiograma od strane dva nezavisna ispitivača prospektivno su analizirani angiogrami 150 dijabetičkih i 150 nedijabetičkih bolesnika sa simptomima ishemijske bolesti mozga. Stupanj stenoze ACI određivan je sukladno kriterijima North American Symptomatic Carotid Endarterectomy Trial (NASCET). Većinu stenoza ekstrakranijalnog dijela ACI čine one na proksimalnom dijelu arterije, a brojnije su u dijabetičkih bolesnika (lijeva ACI – 50,7%, desna ACI – 58,0%) nego u bolesnika bez dijabetesa (lijeva ACI – 29,3%, desna ACI – 32,7%). Kod dijabetičkih bolesnika nađena je značajnija unilateralna zastupljenost tandem stenoza ACI (14,0–21,3%), kao i statistički značajno veća učestalost stenoza intrakranijalnog (i.c.) dijela ACI (lijeva ACI i.c. – 24,0%; desna ACI i.c. – 17,3%) u usporedbi s bolesnicima bez šećerne bolesti (lijeva ACI i.c. – 3,3%; desna ACI i.c. – 3,3%). Rezultati potvrđuju kako u dijabetičkih bolesnika postoji morfološka osnova povećane incidencije promjena na ACI u odnosu na bolesnike bez dijabetesa. Spoznaja o učestalosti razvoja stenotičnih promjena ACI kod dijabetičkih bolesnika naglašava važnost procjene cjelokupnog statusa ACI digitalnom suptrakcijskom angiografijom. Takva je procjena preduvjet optimalnog pristupa liječenju, osobito bolesnika sa šećernom bolešću koji su izloženiji povećanom riziku razvoja cerebrovaskularne bolesti.

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