Abstract

Atherosclerosis , being a systemic disease ,affects coronary arteries , peripheral vasculature as well as cerebral vasculature, sometimes simultaneously. Risk factors for atherosclerosis include increasing age, smoking, diabetes and hypertension. While concomitant involvement of different vascular beds is not so uncommon, such incidence portends poorer prognosis 1. Multiple studies have reported that the prevalence of asymptomatic carotid artery stenosis is quite high in patients with peripheral arterial disease2-5; The prevalence and severity of carotid artery stenosis have been shown to significantly increase in subjects with PAD regardless of the clinical symptoms6 . Crude incidence of stroke ranged from 108 to 172/100,000 people per year, crude prevalence from 26 to 757/100,000 people per year and one-month case fatality rates from 18% to 42%. Incidence of ischemic stroke amounts to about 74% of all stroke cases 7. To prevent ischemic stroke carotid endarterectomy has been recommended in patients with significant extracranial carotid artery stenosis. Asymptomatic Carotid Atherosclerosis Study (ACAS) demonstrated the benefit of performing carotid endarterectomy in selected asymptomatic patients with significant carotid artery stenoses (60% stenosis)7. Carotid duplex ultrasonogram is an accuracy proven non-invasive diagnostic examination to detect carotid artery stenosis. Routine carotid artery screening is not recommended due to relative overall incidence of carotid artery disease. Since the increased incidence of ACAS was well documented in patients with PAD, carotid ultrasonogram screening is helpful in these populations. The goal of this study was to 1) Evaluate the association between PAD and asymptomatic carotid artery stenosis (ACAS), a well-defined asymptomatic measure of cerebrovascular disease; and 2) to identify the specific at “risk population” among the PAD patients who benefit from routine carotid duplex screening

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