Sukun Abdullah, Önal Canver
Radiology, Baskent University Alanya Research and Application Center, Antalya, TUR.
Radiology, Kars Harakani State Hospital, Kars, TUR.
Cureus. 2023 Oct 15;15(10):e47048. doi: 10.7759/cureus.47048. eCollection 2023 Oct.
Factors affecting carotid artery stenosis have been generally investigated. However, considering the protective effect of altitude, studies on elderly individuals at high altitudes are few. Our aim is to investigate the systematic adaptive changes caused by high-altitude exposure through the causes of carotid artery stenosis.
Carotid Doppler ultrasound was performed on 250 patients over the age of 50 years. The patients' age, gender, height, weight, smoking history, place of residence, and presence of comorbidities were questioned. Those with diabetes, hypertension, hyperlipidemia, and coronary disease were excluded from the study. Those who did not reside at high altitudes were excluded from the study. One hundred and thirty-five patients were included in the study. Carotid artery Doppler findings and biochemical parameters were recorded. Factors affecting stenosis in the carotid arteries were compared.
In our study, the factors affecting carotid stenosis were determined to be age, gender, presence of plaque, plaque type, and mean carotid intima-media thickness (CIMT). The mean CIMT of the patients was calculated as 0.71±0.14 mm. The mean CIMT measurement level was significantly higher in patients with plaque in the carotid artery (p<0.05). According to receiver operating characteristic curves, CIMT values higher than 0.72 mm increase plaque and stenosis formation in the common carotid artery (CCA) and internal carotid artery (ICA) in elderly people living at high altitudes (p<0.05, area under the curve [AUC]: 0.71-0.83).
The most important factors affecting carotid stenosis in individuals living at high altitudes are age, gender, CIMT, plaque, and plaque type. When soft plaques were detected, the risk of stenosis was found to be higher than in calcific plaques. Additionally, the number of factors affecting stenosis was greater on the left (ICA). This suggests that the left carotid system is more vulnerable. It can be said that in elderly individuals living at high altitudes, a CIMT higher than 0.72 mm is a cutoff value in the presence of plaque and stenosis in the carotid arteries.
影响颈动脉狭窄的因素已得到广泛研究。然而，考虑到海拔高度的保护作用，针对高海拔地区老年人的研究较少。我们的目的是通过颈动脉狭窄的病因来研究高海拔暴露引起的系统性适应性变化。
对250名50岁以上患者进行颈动脉多普勒超声检查。询问患者的年龄、性别、身高、体重、吸烟史、居住地点以及合并症情况。将患有糖尿病、高血压、高脂血症和冠心病的患者排除在研究之外。将不住在高海拔地区的患者排除在研究之外。135名患者被纳入研究。记录颈动脉多普勒检查结果和生化参数。比较影响颈动脉狭窄的因素。
在我们的研究中，确定影响颈动脉狭窄的因素为年龄、性别、斑块存在情况、斑块类型和平均颈动脉内膜中层厚度（CIMT）。患者的平均CIMT计算为0.71±0.14毫米。颈动脉有斑块的患者平均CIMT测量水平显著更高（p<0.05）。根据受试者工作特征曲线，高于0.72毫米的CIMT值会增加高海拔地区老年人颈总动脉（CCA）和颈内动脉（ICA）中斑块和狭窄的形成（p<0.05，曲线下面积[AUC]：0.71 - 0.83）。
影响高海拔地区人群颈动脉狭窄的最重要因素是年龄、性别、CIMT、斑块和斑块类型。当检测到软斑块时，发现狭窄风险高于钙化斑块。此外，影响左侧（ICA）狭窄的因素数量更多。这表明左侧颈动脉系统更易受损。可以说，在高海拔地区的老年人中，当颈动脉存在斑块和狭窄时，高于0.72毫米的CIMT是一个临界值。
