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https://www.readbyqxmd.com/read/28078914/appropriate-patient-selection-for-carotid-revascularization-procedures-is-urgently-needed
#1
Kosmas I Paraskevas, Frank J Veith, Dimitri P Mikhailidis, Christos D Liapis
The identification/selection of appropriate patient subgroups with asymptomatic carotid artery stenosis and the performance of prophylactic carotid endarterectomy (CEA)/carotid artery stenting (CAS) exclusively on these asymptomatic patient subgroups is currently one of the "hottest" topics in vascular surgery. It is now clear that offering CEA/CAS to asymptomatic carotid patients based only on the degree of carotid stenosis is unjustified and scientifically flawed. On the other hand, offering only best medical therapy to every asymptomatic patient, irrespective of certain high-risk criteria (such as the detection of microemboli by transcranial Doppler, intraplaque hemorrhage, silent embolic infarcts on brain computed tomography/magnetic resonance imaging, elevated biomarkers, family history), is equally wrong...
January 1, 2017: Angiology
https://www.readbyqxmd.com/read/28077455/symptomatic-carotid-occlusion-is-frequently-associated-with-microembolization
#2
Ava L Liberman, Ali Zandieh, Caitlin Loomis, Jonathan M Raser-Schramm, Christina A Wilson, Jose Torres, Koto Ishida, Swaroop Pawar, Rebecca Davis, Michael T Mullen, Steven R Messé, Scott E Kasner, Brett L Cucchiara
BACKGROUND AND PURPOSE: Symptomatic carotid artery disease is associated with significant morbidity and mortality. The pathophysiologic mechanisms of cerebral ischemia among patients with carotid occlusion remain underexplored. METHODS: We conducted a prospective observational cohort study of patients hospitalized within 7 days of ischemic stroke or transient ischemic attack because of ≥50% carotid artery stenosis or occlusion. Transcranial Doppler emboli detection was performed in the middle cerebral artery ipsilateral to the symptomatic carotid...
January 11, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28076634/immediate-versus-delayed-treatment-for-recently-symptomatic-carotid-artery-stenosis
#3
Vladimir Vasconcelos, Nicolle Cassola, Edina Mariko Koga da Silva, José Carlos Costa Baptista-Silva
BACKGROUND: The timing of surgery for recently symptomatic carotid artery stenosis remains controversial. Early cerebral revascularization may prevent a disabling or fatal ischemic recurrence, but it may also increase the risk of hemorrhagic transformation, or of dislodging a thrombus. This review examined the randomized controlled evidence that addressed whether the increased risk of recurrent events outweighed the increased benefit of an earlier intervention. OBJECTIVES: To assess the risks and benefits of performing very early cerebral revascularization (within two days) compared with delayed treatment (after two days) for people with recently symptomatic carotid artery stenosis...
November 2016: São Paulo Medical Journal, Revista Paulista de Medicina
https://www.readbyqxmd.com/read/28073026/the-role-of-visfatin-in-atherosclerotic-peripheral-arterial-obstructive-disease
#4
Matthaios G Pitoulias, Lemonia Skoura, Apostolos G Pitoulias, Dimitris Chatzidimitriou, Apostolia Margariti, Minas Arsenakis, Georgios A Pitoulias
Visfatin is an adipokine molecule acting as an essential coenzyme in multiple cellular redox reactions. The increased serum levels of Visfatin have been correlated with metabolic syndrome and endothelial homeostasis. In this study we investigate the possible relationship of Visfatin serum levels with the severity and location of atherosclerotic peripheral arterial occlusive disease (PAOD). Study protocol included 45 consecutive PAOD and 20 Control patients with age >55years old. Definition of PAOD was based in Rutherord's classification (RC)...
January 7, 2017: Cytokine
https://www.readbyqxmd.com/read/28071288/vulnerable-carotid-plaque-imaging-and-histopathology-without-a-dedicated-mri-receiver-coil
#5
Laura A Fitzpatrick, Nadav Berkovitz, Marlise P Dos Santos, Nevin Majeed, Rafael Glikstein, Santanu Chakraborty, John P Veinot, Grant Stotts, Alain Berthiaume, Robert Chatelain
Stroke is associated with vulnerable carotid artery plaques showing specific histopathologic features, namely a lipid-rich necrotic core, intraplaque hemorrhage, ulceration, and thin fibrous cap. While ultrasound and computed tomography (CT) can identify carotid plaques and determine the extent of stenosis, magnetic resonance imaging (MRI) provides further information regarding plaque composition and morphology. In this feasibility study, three patients with symptomatic, moderately stenosed plaques were imaged with CT angiography (CTA) and MRI (3T and 1...
January 1, 2017: Neuroradiology Journal
https://www.readbyqxmd.com/read/28070049/-common-factors-for-ischemic-cerebral-stroke-in-coronary-artery-bypass-grafting-in-patients-with-concomitant-carotid-and-coronary-artery-severe-stenosis
#6
Lei Huang, Feng Kuang, Zhonggui Shan, Yiquan Lai, Hongwei Guo
To analyze two common factors for perioperative ischemic stroke in patients with concomitant carotid and coronary artery severe stenosis and to improve the therapeutic effect.
 Methods: A total of 44 patients with multi-vessel coronary artery disease combined with carotid stenosis, who admitted to the Department of Cardiac Surgery, the First Affiliated Hospital of Xiamen University from 2008 to 2014, were enrolled in this study. Among them, 32 cases were male, 12 cases was female. All patients received coronary artery bypass grafting after treatment of neck diseases...
December 28, 2016: Zhong Nan da Xue Xue Bao. Yi Xue Ban, Journal of Central South University. Medical Sciences
https://www.readbyqxmd.com/read/28061497/cerebellar-hemorrhage-due-to-a-direct-carotid-cavernous-fistula-after-surgery-for-maxillary-cancer
#7
Yoshinobu Kamio, Hisaya Hiramatsu, Mika Kamiya, Shuhei Yamashita, Hiroki Namba
Infratentorial cerebral hemorrhage due to a direct carotid-cavernous fistula (CCF) is very rare. To our knowledge, only four such cases have been reported. Cerebellar hemorrhage due to a direct CCF has not been reported. We describe a 63-year-old female who presented with reduced consciousness 3 days after undergoing a maxillectomy for maxillary cancer. Computed tomography showed a cerebellar hemorrhage. Magnetic resonance angiography showed a left-sided direct CCF draining into the left petrosal and cerebellar veins through the left superior petrosal sinus (SPS)...
January 1, 2017: Journal of Korean Neurosurgical Society
https://www.readbyqxmd.com/read/28059705/emergent-endovascular-management-of-long-segment-and-flow-limiting-carotid-artery-dissections-in-acute-ischemic-stroke-intervention-with-multiple-tandem-stents
#8
S A Ansari, A L Kühn, A R Honarmand, M Khan, M C Hurley, M B Potts, B S Jahromi, A Shaibani, M J Gounis, A K Wakhloo, A S Puri
BACKGROUND AND PURPOSE: Although most cervical dissections are managed medically, emergent endovascular treatment may become necessary in the presence of intracranial large-vessel occlusions, flow-limiting and long-segment dissections with impending occlusion, and/or hypoperfusion-related ischemia at risk of infarction. We investigated the role of emergent endovascular stenting of long-segment carotid dissections in the acute ischemic stroke setting. MATERIALS AND METHODS: We retrospectively studied long-segment carotid dissections requiring stent reconstruction with multiple tandem stents (≥3 stents) and presenting with acute (<12 hours) ischemic stroke symptoms (NIHSS score, ≥4)...
November 10, 2016: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28057413/upper-extremity-blood-pressure-difference-in-patients-undergoing-carotid-revascularisation
#9
A Huibers, J Hendrikse, M M Brown, S A Pegge, M Arnold, F L Moll, L J Kapelle, G J de Borst
INTRODUCTION: Blood pressure (BP) regulation is important in patients with carotid artery atherosclerotic disease. Concomitant subclavian artery stenosis (SAS) might lead to an underestimation of the true systemic BP in the monitoring of these patients. This study aimed to assess the prevalence of the inter-arm BP difference in patients undergoing carotid intervention and its association with ipsilateral significant subclavian stenosis and clinical outcome. METHODS: Bilateral BP measurements and vascular imaging (CTA and MRA) of both subclavian arteries and the innominate artery were assessed in 182 symptomatic patients with carotid artery stenosis undergoing revascularisation in the International Carotid Stenting Study (ICSS)...
January 2, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28045903/evaluation-of-freehand-b-mode-and-power-mode-3d-ultrasound-for-visualisation-and-grading-of-internal-carotid-artery-stenosis
#10
Johann Otto Pelz, Anna Weinreich, Thomas Karlas, Dorothee Saur
BACKGROUND: Currently, colour-coded duplex sonography (2D-CDS) is clinical standard for detection and grading of internal carotid artery stenosis (ICAS). However, unlike angiographic imaging modalities, 2D-CDS assesses ICAS by its hemodynamic effects rather than luminal changes. Aim of this study was to evaluate freehand 3D ultrasound (3DUS) for direct visualisation and quantification of ICAS. METHODS: Thirty-seven patients with 43 ICAS were examined with 2D-CDS as reference standard and with freehand B-mode respectively power-mode 3DUS...
2017: PloS One
https://www.readbyqxmd.com/read/28045690/clinical-case-of-the-month-a-49-year-old-man-who-presents-with-left-sided-weakness-an-update-on-ischemic-stroke
#11
Najy Masri, Rikki Weems, Falon Brown, Ben Andres, Fred Lopez
A 49 year-old man with a past medical history significant for essential hypertension, hyperlipidemia, and coronary artery disease status post percutaneous coronary intervention and stent placement in the right coronary artery in 2010 presented for evaluation of left hemiplegia. He was feeling well until three hours prior to presentation, at which time he fell while walking from his bedroom into the kitchen. After falling, he noticed that his left upper and lower extremities felt weak. He denied any symptoms preceding the fall or any loss of consciousness...
November 2016: Journal of the Louisiana State Medical Society: Official Organ of the Louisiana State Medical Society
https://www.readbyqxmd.com/read/28030932/usage-of-perioperative-anxiety-neuromarker-for-improving-the-quality-of-life-of-a-patient-operated-on-for-critical-stenosis-of-the-internal-carotid-artery
#12
Mariusz Trystuła, Paweł Półrola, Juri Kropotov
OBJECTIVE: The aim of the study was to find a neuromarker of perioperative anxiety in a patient with critical carotid stenosis through the use of neuromarkers in Quantitative EEG (QEEG) and Event Related Potentials (ERPs). The indirect purpose of the research was evaluation of improvement in the patient's quality of life. CASE STUDY: A 45-year-old woman was admitted to the Department of Vascular Surgery and Endovascular Interventions at the John Paul II Hospital in Krakow, with the diagnosis of critical internal carotid stenosis (over 80%), confirmed by Doppler Ultrasound and Angio-CT examinations...
23, 2016: Annals of Agricultural and Environmental Medicine: AAEM
https://www.readbyqxmd.com/read/28024850/volume-of-subclinical-embolic-infarct-correlates-to-long-term-cognitive-changes-after-carotid-revascularization
#13
Wei Zhou, Brittanie D Baughman, Salil Soman, Max Wintermark, Laura C Lazzeroni, Elizabeth Hitchner, Jyoti Bhat, Allyson Rosen
OBJECTIVE: Carotid intervention is safe and effective in stroke prevention in appropriately selected patients. Despite minimal neurologic complications, procedure-related subclinical microemboli are common and their cognitive effects are largely unknown. In this prospective longitudinal study, we sought to determine long-term cognitive effects of embolic infarcts. METHODS: The study recruited 119 patients including 46% symptomatic patients who underwent carotid revascularization...
December 23, 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28018501/regional-anesthesia-with-dexmedetomidine-infusion-a-feasible-method-for-the-awake-test-during-carotid-endarterectomy
#14
Jonggeun Lee, Up Huh, Seunghwan Song, Sung Woon Chung, Sang Min Sung, Han Jin Cho
Background: Carotid endarterectomy (CEA) is the standard treatment modality for the prevention of stroke in patients with carotid stenosis. This study reports our experiences during CEA with routine awake tests under regional anesthesia (RA) combined with light sedation by dexmedetomidine infusion. Materials and Methods: We retrospectively reviewed 23 patients who had undergone CEA between April 2013 and June 2015. All patients underwent the awake test during CEA with cervical plexus block and light sedation by continuous dexmedetomidine infusion...
2016: Annals of Vascular Diseases
https://www.readbyqxmd.com/read/28018499/advantages-of-selective-use-of-intraluminal-shunt-in-carotid-endarterectomy-a-study-of-122-cases
#15
Muhammad Jamil, Rashid Usman, Salma Ghaffar
Objectives: To assess the advantage of selective use of shunt in carotid endarterectomy (CEA) under local anesthesia. Materials and Methods: A total of 122 consecutive patients fulfilling international guidelines were included. Shunt was used selectively only in cases of bilateral severe carotid artery occlusive disease or in those patients who developed neurological symptoms on clamping of carotid artery. Follow up was done weekly for one month; then every month for 3 months; and then every 3 months for a year...
2016: Annals of Vascular Diseases
https://www.readbyqxmd.com/read/28011672/inflamed-human-carotid-plaques-evaluated-by-pet-ct-exhibit-increased-temperature-insights-from-an-in-vivo-study
#16
Konstantinos Toutouzas, Iosif Koutagiar, Georgios Benetos, Constantina Aggeli, Alexandros Georgakopoulos, Emmanouil Athanasiadis, Nikoletta Pianou, Sofoklis Trachanellis, Nikolaos Patelis, George Agrogiannis, Pavlos Kafouris, Konstantinos Filis, Nikolaos Bessias, Christos Klonaris, George Spyrou, Eleftherios Tsiamis, Elias Siores, Efstratios Patsouris, Dennis Cokkinos, Dimitrios Tousoulis, Constantinos D Anagnostopoulos
AIMS: To explore the relationship between temperature measurements derived by microwave radiometry (MWR) and carotid flurodeoxyglucose (FDG) uptake and assess their association with histological and immunohistochemistry findings in patients with high-grade carotid stenosis. METHODS AND RESULTS: In 21 patients undergoing carotid endarterectomy, carotid inflammation was evaluated by both FDG positron emission/computed tomography (FDG-PET/CT) imaging and MWR measurements...
December 23, 2016: European Heart Journal Cardiovascular Imaging
https://www.readbyqxmd.com/read/28009236/increased-blood-cell-phosphatidylserine-exposure-and-circulating-microparticles-contribute-to-procoagulant-activity-after-carotid-artery-stenting
#17
Lu Zhao, Xiaoming Wu, Yu Si, Zhipeng Yao, Zengxiang Dong, Valerie A Novakovic, Li Guo, Dongxia Tong, He Chen, Yayan Bi, Junjie Kou, Huaizhang Shi, Ye Tian, Shaoshan Hu, Jin Zhou, Jialan Shi
OBJECTIVE Phosphatidylserine (PS) is a major component of the inner leaflet of membrane bilayers. During cell activation or apoptosis, PS is externalized to the outer membrane, providing an important physiological signal necessary for the release of the microparticles (MPs) that are generated through the budding of cellular membranes. MPs express PS and membrane antigens that reflect their cellular origin. PS exposure on the cell surface and the release of MPs provide binding sites for factor Xa and prothrombinase complexes that promote thrombin formation...
December 23, 2016: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28004899/evidence-overview-benefit-of-cerebral-protection-devices-during-carotid-artery-stenting
#18
Jan A Vos
Embolic Protection Devices (EPD's) are often used during Carotid Angioplasty and Stenting (CAS) to reduce procedural cerebral emboli. This manuscript seeks to present an overview of evidence on EPD's during CAS. There are three categories of EPD's: Distal Occlusion (DO-EPD), Filter (F-EPD) and Proximal Occlusion (PO-EPD). DO and F-EPD's have the disadvantage that the device has to be advanced through the stenosis, without protection and that the device may damage the distal internal carotid artery (ICA). F-EPD's have the advantage of maintaining antegrade flow throughout the procedure...
December 22, 2016: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28004633/endovascular-revascularization-of-a-symptomatic-common-carotid-artery-occlusion
#19
Julie Kromm, Tim E Darsaut, Khurshid Khan, Robert Ashforth, Esseddeeg Ghrooda
Although the common carotid artery is the second most common site for extracranial carotid artery stenosis, complete symptomatic occlusion in the absence of devastating stroke is rare. We present a case of complete common carotid artery occlusion failing medical management and requiring endovascular intervention. The clinical presentation, diagnostic investigations, and management of complete carotid artery occlusions are discussed.
January 2017: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
https://www.readbyqxmd.com/read/28004005/clinical-comparison-of-outcomes-of-early-versus-delayed-carotid-artery-stenting-for-symptomatic-cerebral-watershed-infarction-due-to-stenosis-of-the-proximal-internal-carotid-artery
#20
Huakun Liu, Jianfeng Chu, Lei Zhang, Chaolai Liu, Zhongrui Yan, Shengnian Zhou
The aim of this study was to compare the clinical outcomes of early versus delayed carotid artery stenting (CAS) for symptomatic cerebral watershed infarction (sCWI) patients due to stenosis of the proximal internal carotid artery. We retrospectively collected clinical data of those who underwent early or delayed CAS from March 2011 to April 2014. The time of early CAS and delayed CAS was within a week of symptom onset and after four weeks from symptom onset. Clinical data such as second stroke, the National Institutes of Health Stroke Scale (NHISS) score, and modified Rankin Scale (mRS) score and periprocedural complications were collected...
2016: BioMed Research International
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