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carotid artery stenosis; CVA

Prakrity Urja, Eric H Nippoldt, Virginia Barak, Carrie Valenta
Value-based care emphasizes achieving the greatest overall health benefit for every dollar spent. We present an interesting case of stroke, which made us consider how frequently health care providers are utilizing value-based care. A 73-year-old Caucasian, who was initially admitted for a hypertensive emergency, was transferred to our facility for worsening slurring of speech and left-sided weakness. The patient had an extensive chronic cerebrovascular disease, including multiple embolic type strokes, mainly in the distribution of the right temporal-occipital cerebral artery and transient ischemic attacks (TIAs)...
August 1, 2017: Curēus
Roger Härtl, Marjan Alimi, Mohamed Abdelatif Boukebir, Connor D Berlin, Rodrigo Navarro-Ramirez, Paul M Arnold, Michael G Fehlings, Thomas E Mroz, K Daniel Riew
STUDY DESIGN: Retrospective study and literature review. OBJECTIVE: To provide more comprehensive data about carotid artery injury (CAI) or cerebrovascular accident (CVA) related to anterior cervical spine surgery. METHODS: We conducted a retrospective, multicenter, case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network. Medical records of 17 625 patients who went through cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, were analyzed...
April 2017: Global Spine Journal
A Leonard
CASE: A 44 year old woman with a history of stroke s/p aneurysm clipping, seizure, and substance abuse was brought to the hospital after a family member received a call from her friend saying she was acting unusual and may have had a seizure while hanging out on the street. At her baseline, she needed modest assistance in daily activities after her CVA and conversed without issue. Her mother died of a stroke. On exam the patient was afebrile, normotensive with mild tachycardia to 110...
March 2017: Journal of the Louisiana State Medical Society: Official Organ of the Louisiana State Medical Society
Dallit Mannheim, Ron Karmeli
BACKGROUND: For an asymptomatic patient with severe carotid stenosis the most important question is how to prevent an ischemic stroke. Carotid artery stenosis is the estimated cause of stroke in 8-20% of the cases. Today more than 50% of procedures for carotid stenosis are done on asymptomatic patients, but few of the randomized controlled trials comparing carotid endarterectomy and stenting examined specifically these patients. METHODS: All patients with severe (>70%) asymptomatic carotid artery stenosis seen in the Carmel medical center vascular clinic were prospectively screened and randomized 1:1 for carotid endarterectomy (CEA) or carotid stenting (CAS)...
December 2017: Journal of Cardiovascular Surgery
Farhad Assarzadegan, Hanif Tabesh, Arya Shoghli, Mahmood Ghafoori Yazdi, Hadi Tabesh, Parnaz Daneshpajooh, Mehdi Yaseri
BACKGROUND: Although the risk factors of ischemic strokes are well defined, there is slight information about their relations with the etiologies of ischemic strokes. This study investigated the distribution of ischemic stroke risk factors and their connections to diverse etiologies of cerebrovascular attack (CVA) and specific ischemic regions of brain. METHODS: In this cross sectional study, we analyzed the data of patients with definite diagnosis of CVA, excluding hemorrhagic strokes, registered in Imam Hossein Medical Center in Tehran, Iran...
October 2015: Iranian Journal of Public Health
Badih Daou, Nohra Chalouhi, Robert M Starke, Richard Dalyai, Adam Polifka, Kumar Sarkar, Pascal Jabbour, Robert Rosenwasser, Stavropoula Tjoumakaris
BACKGROUND: Variable rates of restenosis after carotid artery stenting (CAS) have been reported, and few predictors have been suggested. Because CAS is being performed with increasing frequency, more data are needed to evaluate the rate and predictors of restenosis and possibly identify new risk factors for restenosis after CAS. The aim of this study was to analyze the rate and predictors of restenosis after CAS. METHODS: 241 patients with carotid artery stenosis treated with stenting were analyzed retrospectively to identify patients who had restenosis after stenting...
July 2016: Journal of Neurointerventional Surgery
Grzegorz Brzezicki, Dennis J Rivet, John Reavey-Cantwell
BACKGROUND: Most cervical dissections are treated with anticoagulation or antiplatelet agents with very good results; however, some patients may benefit from endovascular intervention. High cervical and skull base dissections are often more challenging to treat because of the distal location and tortuous anatomy. The Pipeline Embolization Device (PED) may be a reasonable treatment option for this indication. OBJECTIVES: To report a case series of patients treated with the PED for high cervical and skull base dissections, focusing on their presentation, indications for treatment, dissection revascularization success, and pseudoaneurysm obliteration evaluated by imaging, and to review available pertinent literature...
July 2016: Journal of Neurointerventional Surgery
M Raffaelli, A Santoliquido, P Tondi, L Revelli, P Kateta Tshibamba, C DE Crea, A D'Amore, R Bellantone, C P Lombardi
Surgical manipulation of the cervical vascular bundle during neck surgery may promote a thromboembolic event. We evaluated if thyroid surgery is associated with any alterations in the carotid artery wall that would imply an augmented risk of cerebrovascular accident (CVA). A prospective evaluation of a consecutive series of patients who underwent total thyroidectomy was performed. High resolution Doppler ultrasonography (HR-DU) was performed the day before and three days after surgery in asymptomatic consenting patients scheduled for total thyroidectomy...
February 2015: Acta Otorhinolaryngologica Italica
Mathew Cooke, Michael A Cuddy, Brad Farr, Paul A Moore
Stroke, or cerebrovascular accident (CVA), is a medical emergency that may lead to permanent neurological damage, complications, and death. The rapid loss of brain function due to disruption of the blood supply to the brain is caused by blockage (thrombosis, arterial embolism) or hemorrhage. The incidence of CVA during anesthesia for noncardiac nonvascular surgery is as high as 1% depending on risk factors. Comprehensive preoperative assessment and good perioperative management may prevent a CVA. However, should an ischemic event occur, appropriate and rapid management is necessary to minimize the deleterious effects caused to the patient...
2014: Anesthesia Progress
A S Tuladhar, A Shrestha, P Adhikari, L N Joshi, G R Sharma
A prospective study was carried out during 2010 - 2011 in the Department of Radiology & Imaging of Nepal Medical College and Teaching Hospital, Jorpati, Kathmandu and Om Hospital and Research Centre, Chabahil, Kathmandu in which a total of 45 patients with clinically and CT scan diagnosed ischaemic cerebrovascular accident (CVA) underwent carotid Doppler study. During the hospital stay these patients also underwent lipid profile estimation to see for presence or absence of hyperlipidemia. Of these 45 patients, CT scan showed left middle cerebral artery (MCA) infarctions in 12, right MCA infarction in 12, lacunar infarctions in 10, watershed territory infarction in 4, posterior circulation infarction in 1 and venous infarction in 1 patient...
June 2013: Nepal Medical College Journal: NMCJ
Maria Sol Calero Revelo, Daniel Pio de Oliveira, Flávia Bittar Britto Arantes, Camila Camarço Batista, João Italo Dias França, Silmara Cristina Friolani, Jorge Eduardo Assef, José Eduardo Martins Barbosa, Ana Claudia Petisco, Pedro Silvio Farsky
BACKGROUND: Approximately 30% of perioperative CVA of myocardial revascularization surgery (MRS) are a result of carotid injuries, without reduction of risk confirmed by perioperative intervention. OBJECTIVES: Evaluate the impact of carotid disease and perioperative intervention in patients subjected to MRS. METHODS: Observational, retrospective study, evaluating 1169 patients aged > 69 years undergoing MRS from January, 2006 and December, 2010, monitored, on average, for 49 months...
October 2013: Arquivos Brasileiros de Cardiologia
V S Shishkina, L R Toklueva, S V Kashirina, N V Radiukhina, O P Il'inskaia, V V Akhmetov, I P Mikhaĭlov, A V Troitskiĭ, T V Balakhonova, E Iu Strazden', M A Shariia, M M Luk'ianov, S A Boĭtsov, E M Tararak
A complex histomorphometric and clinical-instrumental analysis of atherosclerotic lesions of the carotid arteries obtained during carotid endarterectomies (CEE) of patients with hemodynamically significant stenoses was conducted. Two groups of patients were compared: symptomatic, which earlier underwent cerebral vascular accident (CVA) or transitory ischemic attacks (TIA), and asymptomatic ones with no complications of the disease. Statistical analysis of clinical and laboratory data showed no significant differences between two groups except for the level of lipoprotein(a) [Lp(a)] in the blood plasma, which was higher (p<0...
2013: Kardiologiia
Joé L P Kolkert, Rolf H H Groenwold, Juliette T M Blauw, Robbert Meerwaldt, Clark J Zeebregts, R H Geelkerken
OBJECTIVE: To gain insight into the duration and the various components of the clinical treatment course for patients with symptomatic carotid artery stenosis, in order to improve the care provided to these patients. DESIGN: Retrospective cohort study. METHODS: All patients who had undergone a carotid intervention for significant symptomatic carotid stenosis from 2001 to 2011 were included. Quantile regression analysis was used to assess the changes which had occurred in the median duration of the period from neurological event to intervention from 2001 onward...
2013: Nederlands Tijdschrift Voor Geneeskunde
Mahrokh Imanimoghaddam, Mohammad Rah Rooh, Elahe Mahmoudi Hashemi, Abbas Javadzade Blouri
BACKGROUND AND AIMS: The purpose of this study was to identify patients at the risk of cerebrovascular attack (CVA) by detecting calcified carotid artery atheroma (CCAA) in panoramic radiography and evaluating their risk factors. MATERIALS AND METHODS: A total of 960 panoramic radiographs of patients above 40 years old were evaluated. Doppler Sonography (DS) was performed for patients who showed calcified carotid artery atheroma (CCAA) in panoramic radiogra-phy in order to determine the presence of CCAA and the degree of stenosis...
2012: Journal of Dental Research, Dental Clinics, Dental Prospects
Piotr P Buszman, Radosław Szymański, Marcin Dębiński, Krzysztof Milewski, Marek Król, Przemyslaw Nowakowski, R Stefan Kiesz, Martin G Radvany, Szymon Wiernek, Barbara Wiernek, Pawel E Buszman
INTRODUCTION: Carotid artery stenting (CAS) has become an alternative to carotid endarterectomy. Moreover, percutaneous transluminal angioplasty (PTA) allows other cephalad arteries revascularization. The aim of this study was to evaluate late outcomes of cephalad arteries PTA. METHODS: This is an international multicenter registry of 434 consecutive patients in which 497 PTAs were performed. Patients with symptomatic >50% stenosis or asymptomatic >70% stenosis were enrolled...
March 1, 2012: Catheterization and Cardiovascular Interventions
Luke P Brewster, Robert Beaulieu, Matthew A Corriere, Ravi Veeraswamy, Khusrow A Niazi, Gregory Robertson, Thomas F Dodson, Karthik Kasirajan
INTRODUCTION: Contradictory outcomes exist for different methods of carotid artery revascularization. Here we provide the comparative rates of adverse events in patients after carotid endarterectomy (CEA), carotid artery stenting (CAS) with a distal embolic protection device (EPD), and CAS with a proximal flow reversal system (FRS) from a single institution by various specialists treating carotid artery disease. METHODS: Procedural billing codes and the electronic medical records of patients undergoing revascularization for carotid artery stenosis from February 2007 through March 2010 were used for data collection...
October 2011: Journal of Vascular Surgery
Brian G Derubertis, Robert L Hynecek, K Craig Kent, Peter L Faries
INTRODUCTION: Anatomic distortion associated with radiation-induced tissue changes may pose challenges for patients with prior cervical irradiation undergoing carotid stenting. We sought to evaluate the effect of these changes on carotid intervention. METHODS: Carotid angioplasty and stenting (CAS) for high-grade stenosis was performed in 203 patients. In all, 12 consecutive patients with prior ipsilateral cervical irradiation were age-/sex-matched to 24 controls...
October 2011: Vascular and Endovascular Surgery
M Rizwan Khalid, Fatima Khalid, F Ali Farooqui, Diana Dragoi, Khusrow Niazi
AIMS: It has been stated that experienced physicians with a high volume of carotid artery stent (CAS) procedures have low complication rates, including cerebrovascular accidents (CVA). Complication rates, however, are not known for physicians with a low volume of CAS (<50 CAS/yr) but with a high volume of other peripheral endovascular procedures. Since the techniques used in CAS are similar to those used routinely in other peripheral interventions, we hypothesise that high volume peripheral interventional operators with appropriate training would have low complication rates during CAS procedures...
January 2011: EuroIntervention
Giuseppe De Luca, Monica Verdoia, Ettore Cassetti, Alon Schaffer, Chiara Cavallino, Virginia Bolzani, Paolo Marino
Few reports have so far investigated the relationship between fibrinogen levels and the extent of coronary artery disease (CAD) as evaluated by coronary angiography, that is therefore the aim of the current study. We measured fibrinogen in 2,121 consecutive patients undergoing coronary angiography. Patients were divided in 5 groups based on quintiles of fibrinogen levels. Significant CAD was defined as stenosis >50% in at least 1 coronary vessel. We additionally measured carotid intima-media thickness (CIMT) in a subgroup of 359 patients...
May 2011: Journal of Thrombosis and Thrombolysis
Parth S Shah, Anil Hingorani, Enrico Ascher, Alexander Shiferson, Nirav Patel, Kapil Gopal
Recanalization after extracranial internal carotid artery (ICA) occlusion is a rare phenomenon and the natural history of the disease is largely unknown. There have been few cases reported in the published data, including early recanalization after a cerebrovascular accident (CVA). We report a case of a 74-year-old man who presented with a CVA and a history of multiple CVAs in the past, the last episode being a year ago. Multiple imaging modalities, including duplex scans, computerized tomographic angiograms, and fluoroscopy-guided angiogram of bilateral carotid arteries, showed occlusion of the left ICA in the past...
October 2010: Annals of Vascular Surgery
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