Ultrasound assessed carotid atherosclerosis in a general population : the Tromsø study

Abstract

As a neurologist with a special interest in cerebrovascular diseases, and with several years of practice with ultrasound examinations of extra- and intracranial arteries, I have some times experienced patients in whom ultrasound revealed unexpected findings which surprised mc, and made me wonder about etiological relationships and clinical implications. Thus, ultrasound examinations of the carotid arteries in some very old people showed smooth vessels without visible atherosclerosis, whereas in some young people with low cardiovascular risk factor levels, I found pronounced atherosclerosis with stenotic or occluded carotid arteries. Similarly, I have wondered why many patients with high-degree carotid stenosis did not suffer from ipsilateral ischemic cerebral stroke, whereas others who had a lower degree of stenosis experienced cerebral embolic events and had carotid endarterectomy. Was one of the causes that atherosclerosis might be a condition differing also in terms of pathogenicity? Such unexpected and intriguing findings evoked my curiosity for a more scientific approach to carotid atherosclerosis. The opportunity arose when I was invited to participate in the fourth survey of the Tromsø Study.