[RESUMEN]

Introducción: Existe poca información sobre la frecuencia de la aterosclerosis en los muy jóvenes.

Objetivo: Describir la prevalencia y severidad de la aterosclerosis carotídea e intracraneal en sujetos menores a 18 años de edad.

Métodos: Realizamos un análisis prospectivo sobre 32 menores quienes recibieron autopsia debido a causas legales, principalmente muertes por trauma accidental. Todos los sujetos tenían arterias carótidas e intracraneales indemnes y adecuadas para examen histopatológico. Las placas ateromatosas se clasificaron de acuerdo al sistema de la American Heart Association (grado 0 = normal, grado I = lesión inicial, grado II = estría grasa, grado III = estría grasa elevada, grado IV = ateroma, grado V = fibroateroma, grado VI = lesión complicada).

Resultados: Hubo 18 (56.2%) mujeres. La edad promedio fue de 6.5 años (mediana: 4.5, rango: 1 a 17 años). Sólo 8 (28.6%) sujetos eran mayores de 12 años. Ninguno de los pacientes padecía de diabetes, hipertensión, dislipidemia o historia familiar de muerte cardiovascular temprana. Sólo un sujeto tenía el antecedente de consumo de alcohol y tabaco. Un total de 21 (65.5%) sujetos tenían carótidas normales, 4 (12.5%) tenían lesiones grado I, y 7 (21.9%) grado III. El polígono de Willis fue normal en 19 (67.9%) sujetos, 1 (3.6%) tenía lesiones grado I, 6 (21.4%) grado II, 1 (3.6%) grado IV y 1 (3.6%) grado V. No se identificaron lesiones complicadas ni estenóticas. La severidad de la aterosclerosis correlacionó entre ambas carótidas (rho de Spearman 0.569, p=0.001), pero sorprendentemente no entre carótidas y polígono de Willis.dierctamente  EM. de autoinmunidad se asocilos pacientes con EM fueron mcto personal de la enfermedad y la carga sanitaria de tr

Conclusiones: Lesiones incipientes del espectro de la aterosclerosis pueden encontrarse hasta en 30% de las arterias intracraneales y carótidas de mexicanos muy jóvenes.

Palabras clave: Aterosclerosis, autopsia, carótidas, intracraneal, niños, pediatría.

[ABSTRACT]

Carotid and Intracranial Atherosclerosis in a Pediatric population: An autopsy Study

Introduction: Limited information exists on the frequency of atherosclerosis in the very young.

Objective: To describe the prevalence and severity of carotid and intracranial artery disease in subjects under the age 18 years.

Methods: A prospective analysis was performed on 32 subjects aged <18 years who underwent mandatory autopsy due to legal issues, mainly accidental deaths due to trauma. All these subjects had carotid and intracranial arteries undamaged and suitable for histopathological examination. Atheromatous plaques were graded according to the American Heart Association system (grade 0 = normal, grade I = initial lesion, grade II = fatty streak, grade III = raised fatty streak, grade IV = atheroma, grade V = fibroatheroma, grade VI = complicated lesion).

Results: There were 18 (56.2%) females. Mean age was 6.5 years (median: 4.5, range: 1 to 17 years). Only eight (28.6%) subjects were older than 12 years. None of the patients had diabetes, hypertension, dyslipidemia or family history of early cardiovascular death. Only one subject had history of regular alcohol intake and smoking habit. Twenty-one (65.6%) subjects had normal carotids, four (12.5%) had grade I, and seven (21.9%) grade III lesions. The circle of Willis was normal in 19 (67.9%) subjects, one (3.6%) had grade I, six (21.4%) grade II, one (3.6%) grade IV and one (3.6%) grade V lesions. Neither complicated, nor advanced stenotic plaques were identified. Severity of atherosclerosis significantly correlated between both carotid arteries (Spearman’s rho 0.569, p=0.001), but surprisingly not with intracranial arteries.

Conclusion: Incipient lesions of the atherosclerosis spectrum can be found in about 30% of intracranial and carotid arteries in very young Mexican individuals.

Keywords: Atherosclerosis, autopsy, carotids, children, intracranial, pediatrics.