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Asymptomatic carotid stenosis

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https://www.readbyqxmd.com/read/28318997/diastolic-blood-pressure-is-a-risk-factor-for-peri-procedural-stroke-following-carotid-endarterectomy-in-asymptomatic-patients
#1
D D de Waard, G J de Borst, R Bulbulia, A Huibers, A Halliday
OBJECTIVE/BACKGROUND: Carotid endarterectomy (CEA) prevents future stroke, but this benefit depends on detection and control of high peri-operative risk factors. In symptomatic patients, diastolic hypertension has been causally related to procedural stroke following CEA. The aim was to identify risk factors causing peri-procedural stroke in asymptomatic patients and to relate these to timing of surgery and mechanism of stroke. METHODS: In the first Asymptomatic Carotid Surgery Trial (ACST-1), 3,120 patients with severe asymptomatic carotid stenosis were randomly assigned to CEA plus medical therapy or to medical therapy alone...
March 16, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28300680/evaluation-by-mri-of-silent-brain-infarcts-in-pre-and-post-operative-asymptomatic-carotid-surgery
#2
Remy Pascot, Anne Daoudal, Alain Cardon, Gilles Godet, Antoine Lucas, Elodie Clochard, Jean-Yves Gauvrit, Yann Le Teurnier, Adrien Kaladji
OBJECTIVE: To report the prevalence of Silent Brain Infarcts (SBI) at MRI before and after surgery for asymptomatic high grade carotid stenosis. DESIGN: Single-center retrospective observational study METHODS: Asymptomatic patients who underwent carotid endarterectomy between October 2012 and October 2014 were included. The preoperative assessment included a Doppler and a CT scan dating less than 3 months. A neurological examination was performed during the anesthesia consultation and in the 15 days before surgery...
March 11, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28298048/carotid-atherosclerotic-plaque-instability-and-cognition-determined-by-ultrasound-measured-plaque-strain-in-asymptomatic-patients-with-significant-stenosis
#3
Robert J Dempsey, Tomy Varghese, Daren C Jackson, Xiao Wang, Nirvedh H Meshram, Carol C Mitchell, Bruce P Hermann, Sterling C Johnson, Sara E Berman, Stephanie M Wilbrand
OBJECTIVE This article describes the use of ultrasound measurements of physical strain within carotid atherosclerotic plaques as a measure of instability and the potential for vascular cognitive decline, microemboli, and white matter changes. METHODS Asymptomatic patients with significant (> 60%) carotid artery stenosis were studied for dynamic measures of plaque instability, presence of microemboli, white matter changes, and vascular cognitive decline in comparison with normative controls and premorbid state...
March 10, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28292859/-18-f-fluoride-and-18-f-fluorodeoxyglucose-positron-emission-tomography-after-transient-ischemic-attack-or-minor-ischemic-stroke-case-control-study
#4
Alex T Vesey, William S A Jenkins, Agnese Irkle, Alastair Moss, Greg Sng, Rachael O Forsythe, Tim Clark, Gemma Roberts, Alison Fletcher, Christophe Lucatelli, James H F Rudd, Anthony P Davenport, Nicholas L Mills, Rustam Al-Shahi Salman, Martin Dennis, William N Whiteley, Edwin J R van Beek, Marc R Dweck, David E Newby
BACKGROUND: Combined positron emission tomography (PET) and computed tomography (CT) can assess both anatomy and biology of carotid atherosclerosis. We sought to assess whether (18)F-fluoride or (18)F-fluorodeoxyglucose can identify culprit and high-risk carotid plaque. METHODS AND RESULTS: We performed (18)F-fluoride and (18)F-fluorodeoxyglucose PET/CT in 26 patients after recent transient ischemic attack or minor ischemic stroke: 18 patients with culprit carotid stenosis awaiting carotid endarterectomy and 8 controls without culprit carotid atheroma...
March 2017: Circulation. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28291675/choices-of-stent-and-cerebral-protection-in-the-ongoing-acst-2-trial-a-descriptive-study
#5
D D de Waard, A Halliday, G J de Borst, R Bulbulia, A Huibers, R Casana, L H Bonati, V Tolva
OBJECTIVE/BACKGROUND: Several plaque and lesion characteristics have been associated with an increased risk for procedural stroke during or shortly after carotid artery stenting (CAS). While technical advancements in stent design and cerebral protection devices (CPD) may help reduce the procedural stroke risk, and anatomy remains important, tailoring stenting procedures according to plaque and lesion characteristics might be a useful strategy in reducing stroke associated with CAS. In this descriptive report of the ongoing Asymptomatic Carotid Surgery Trial-2 (ACST-2), it was assessed whether choice for stent and use or type of CPD was influenced by plaque and lesion characteristics...
March 11, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28290390/prevalence-and-risk-factors-of-asymptomatic-carotid-artery-stenosis-in-indian-population-an-8-year-follow-up-study
#6
Subhash Kaul, Suvarna Alladi, K Rukmini Mridula, V C S Srinivasarao Bandaru, Matapathi Umamashesh, Darapureddy Anjanikumar, Palli Lalitha, R Chandrasekhar
BACKGROUND: Asymptomatic carotid artery stenosis (ACAS) is a marker for cerebrovascular disease, coronary atherosclerosis, and death. AIM: To investigate the prevalence of ACAS in the Indian population, and to correlate ACAS with other vascular risk factors. MATERIALS AND METHODS: We prospectively recruited 1500 individuals who were older than 40 years and asymptomatic for cerebrovascular disease between June 2003 and December 2014. Evaluation of vascular risk factors was done for all the participants...
March 2017: Neurology India
https://www.readbyqxmd.com/read/28288976/risk-of-inhospital-stroke-or-death-is-associated-with-age-but-not-sex-in-patients-treated-with-carotid-endarterectomy-for-asymptomatic-or-symptomatic-stenosis-in-routine-practice-secondary-data-analysis-of-the-nationwide-german-statutory-quality-assurance-database
#7
Sofie Schmid, Pavlos Tsantilas, Christoph Knappich, Michael Kallmayer, Thomas König, Thorben Breitkreuz, Alexander Zimmermann, Andreas Kuehnl, Hans-Henning Eckstein
BACKGROUND: Guideline recommendations on carotid endarterectomy are based predominantly on randomized, controlled trials, in which women or elderly patients are often under-represented. This study analyzed the association of age and sex with the risk of in-hospital stroke or death following carotid endarterectomy under routine conditions in Germany. METHODS AND RESULTS: Secondary data analysis using the Statutory German Quality Assurance Database on all carotid endarterectomy procedures (n=142 074) performed between 2009 and 2014...
March 13, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28283609/intraoperative-completion-studies-local-anesthesia-and-antiplatelet-medication-are-associated-with-lower-risk-in-carotid-endarterectomy
#8
Christoph Knappich, Andreas Kuehnl, Pavlos Tsantilas, Sofie Schmid, Thorben Breitkreuz, Michael Kallmayer, Alexander Zimmermann, Hans-Henning Eckstein
BACKGROUND AND PURPOSE: In Germany, all surgical and endovascular procedures on the carotid bifurcation must be documented in a statutory nationwide quality assurance database. We aimed to analyze the association between procedural and perioperative variables and in-hospital stroke or death rates after carotid endarterectomy. METHODS: Between 2009 and 2014, overall 142 074 elective carotid endarterectomy procedures for asymptomatic or symptomatic carotid artery stenosis were documented in the database...
March 10, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28274755/semiautomatic-quantification-of-carotid-plaque-volume-with-three-dimensional-ultrasound-imaging
#9
Amir A Khan, Christian Koudelka, Carly Goldstein, Limin Zhao, John Yokemick, Moira Dux, Siddhartha Sikdar, Brajesh K Lal
OBJECTIVE: Vessel wall volume (VWV) assessed by three-dimensional duplex ultrasound (3DUS) imaging provides a more comprehensive measure of plaque burden than conventional two-dimensional measures of diameter stenosis. We previously demonstrated that manual outlining of the arterial lumen-intima boundary and outer wall boundary can be performed reliably on images obtained with a commercially available 3D-DUS transducer. Manual segmentation, however, is time consuming (∼45 minutes), limiting its clinical translation...
March 5, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28274754/noninvasive-characterization-of-carotid-plaque-strain
#10
Amir A Khan, Siddhartha Sikdar, Thomas Hatsukami, Juan Cebral, Michael Jones, John Huston, George Howard, Brajesh K Lal
OBJECTIVE: Current risk stratification of internal carotid artery plaques based on diameter-reducing percentage stenosis may be unreliable because ischemic stroke results from plaque disruption with atheroembolization. Biomechanical forces acting on the plaque may render it vulnerable to rupture. The feasibility of ultrasound-based quantification of plaque displacement and strain induced by hemodynamic forces and their relationship to high-risk plaques have not been determined. We studied the feasibility and reliability of carotid plaque strain measurement from clinical B-mode ultrasound images and the relationship of strain to high-risk plaque morphology...
March 5, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28274551/carotid-stenosis-treatment-variation-in-international-practice-patterns
#11
M Venermo, G Wang, A Sedrakyan, J Mao, N Eldrup, R DeMartino, K Mani, M Altreuther, B Beiles, G Menyhei, G Danielsson, I Thomson, G Heller, C Setacci, M Björck, J Cronenwett
OBJECTIVES: The aim was to determine current practice for the treatment of carotid stenosis among 12 countries participating in the International Consortium of Vascular Registries (ICVR). METHODS: Data from the United States Vascular Quality Initiative (VQI) and the Vascunet registry collaboration (including 10 registries in Europe and Australasia) were used. Variation in treatment modality of asymptomatic versus symptomatic patients was analysed between countries and among centres within each country...
March 5, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28260723/evidence-based-carotid-interventions-for-stroke-prevention-state-of-the-art-review
#12
Dylan R Morris, Kengo Ayabe, Takashi Inoue, Nobuyuki Sakai, Richard Bulbulia, Alison Halliday, Shinya Goto
Carotid artery stenosis is responsible for between 10-20% of all ischaemic strokes. Interventions, such as carotid endarterectomy and carotid stenting, effectively reduce the risk of stroke in selected individuals. This review describes the history of carotid interventions, and summarises reliable evidence on the safety and efficacy of these interventions gained from large randomised clinical trials.Early trials comparing carotid endarterectomy to medical therapy alone in symptomatic patients, and asymptomatic patients, demonstrated that endarterectomy halved the risk of stroke and perioperative death in these two unique populations...
March 4, 2017: Journal of Atherosclerosis and Thrombosis
https://www.readbyqxmd.com/read/28255464/impairments-in-brain-perfusion-metabolites-functional-connectivity-and-cognition-in-severe-asymptomatic-carotid-stenosis-patients-an-integrated-mri-study
#13
Tao Wang, Feng Xiao, Guangyao Wu, Jian Fang, Zhenmeng Sun, Hongliang Feng, Junjian Zhang, Haibo Xu
Carotid artery stenosis without transient ischemic attack (TIA) or stroke is considered as "asymptomatic." However, recent studies have demonstrated that these asymptomatic carotid artery stenosis (aCAS) patients had cognitive impairment in tests of executive function, psychomotor speed, and memory, indicating that "asymptomatic" carotid stenosis may not be truly asymptomatic. In this study, when 19 aCAS patients compared with 24 healthy controls, aCAS patients showed significantly poorer performance on global cognition, memory, and executive function...
2017: Neural Plasticity
https://www.readbyqxmd.com/read/28252318/oxidative-injury-associated-with-stenting-of-asymptomatic-carotid-artery-stenosis
#14
Erhan Saraçoğlu, Ertan Vuruşkan, Yusuf Çekici, Salih Kiliç, Halil Ay, Uğur Ergün
BACKGROUND: After carotid artery stenting (CAS), neurological complications that cannot be explained with imaging methods may develop. In our study we aimed to show, using oxidative stress markers, isolated oxidative damage and resulting neurological findings following CAS in patients with asymptomatic carotid artery stenosis. PATIENTS AND METHODS: We included 131 neurologically asymptomatic patients requiring CAS. The neurological findings were evaluated using the modified Rankin Scale (mRS) prior to the procedure, one hour post-procedure, and two days after...
March 2, 2017: VASA. Zeitschrift Für Gefässkrankheiten
https://www.readbyqxmd.com/read/28249083/provider-induced-demand-in-the-treatment-of-carotid-artery-stenosis-variation-in-treatment-decisions-between-private-sector-fee-for-service-vs-salary-based-military-physicians
#15
Louis L Nguyen, Ann D Smith, Rebecca E Scully, Wei Jiang, Peter A Learn, Stuart R Lipsitz, Joel S Weissman, Lorens A Helmchen, Tracey Koehlmoos, Andrew Hoburg, Linda G Kimsey
Importance: Although many factors influence the management of carotid artery stenosis, it is not well understood whether a preference toward procedural management exists when procedural volume and physician compensation are linked in the fee-for-service environment. Objective: To explore evidence for provider-induced demand in the management of carotid artery stenosis. Design, Setting, and Participants: The Department of Defense Military Health System Data Repository was queried for individuals diagnosed with carotid artery stenosis between October 1, 2006, and September 30, 2010...
March 1, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28248915/-phacing-a-new-cause-of-carotid-artery-dissection
#16
Caterina Kulyk, Filippo Farina, Anna Palmieri, Federica Viaro, Francesco Causin, Anna M Laverda, Claudio Baracchini
INTRODUCTION: Cervical arterial dissection (CAD) is a frequent and preventable cause of ischemic stroke in young patients. Several arguments suggest that genetic and developmental disorders could play an important role as part of a multifactorial predisposition of sporadic CAD.We present 2 cases of young patients with CAD in association with cutaneous lesions and nonatherosclerotic multivessel arteriopathy. CASE REPORTS: Our first patient was a 17-year-old white girl with sudden onset of weakness in her right upper limb...
March 2017: Neurologist
https://www.readbyqxmd.com/read/28236046/prevalence-and-distribution-of-calcified-nodules-in-carotid-arteries-in-correlation-with-clinical-symptoms
#17
Karolin Johanna Paprottka, Damiana Saam, Johannes Rübenthaler, Andreas Schindler, Nora Navina Sommer, Philipp Marius Paprottka, Dirk André Clevert, Maximilian Reiser, Tobias Saam, Andreas Helck
PURPOSE: Calcified nodules ("CN") are responsible for up to 5% of coronary-infarcts and, therefore, classified as minor criteria of "vulnerable" atherosclerotic plaque. We sought to evaluate prevalence and distribution of CN in carotid arteries in correlation with clinical symptoms. METHODS: 178 consecutive patients with unilateral ischemic stroke and carotid plaques ≥2 mm by duplex ultrasound underwent a carotid-black-blood-3T-MRI with fat-saturated pre- and post-contrast T1w-, PDw-, T2w- and TOF images using dedicated surface-coils...
February 24, 2017: La Radiologia Medica
https://www.readbyqxmd.com/read/28218798/shear-wave-elastography-imaging-for-the-features-of-symptomatic-carotid-plaques-a-feasibility-study
#18
Zhe Lou, Jun Yang, Li Tang, Youhe Jin, Jinsong Zhang, Chao Liu, Qiaobei Li
OBJECTIVES: Shear wave elastography (SWE) was performed to evaluate the Young's modulus of carotid plaques in patients presenting with cerebrovascular incidents, to estimate the clinical value and feasibility of this approach. METHODS: Sixty-one patients (mean age, 65 years; 45 men) underwent common duplex ultrasonic examination and SWE evaluation. The patients were divided into the symptomatic and asymptomatic groups based on the presence of unilateral focal neurological symptoms...
February 20, 2017: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/28217385/silent-ischemic-lesion-laterality-in-asymptomatic-internal-carotid-artery-stenosis-relates-to-reduced-cerebral-vasoreactivity
#19
Makoto Isozaki, Hiroharu Kataoka, Kazuhito Fukushima, Hatsue Ishibashi-Ueda, Naoaki Yamada, Hidehiro Iida, Koji Iihara
BACKGROUND: We investigated the relationship between silent ischemic lesions, defined as hyperintense lesions on T2-weighted magnetic resonance imaging scans of brain white matter and cerebral hemodynamics (baseline cerebral blood flow and cerebral vasoreactivity). METHODS: Between January 2007 and December 2012, 61 patients with asymptomatic internal carotid artery stenosis were evaluated for asymptomatic silent ischemic lesions, acute infarction, and cerebral hemodynamics...
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/28190714/carotid-endarterectomy-should-not-be-based-on-consensus-statement-duplex-velocity-criteria
#20
Jesse A Columbo, Bjoern D Suckow, Claire L Griffin, Jack L Cronenwett, Philip P Goodney, Timothy G Lukovits, Robert M Zwolak, Mark F Fillinger
OBJECTIVE: Randomized trials support carotid endarterectomy (CEA) in asymptomatic patients with ≥60% internal carotid artery (ICA) stenosis. The widely referenced Society for Radiologists in Ultrasound Consensus Statement on carotid duplex ultrasound (CDUS) imaging indicates that an ICA peak systolic velocity (PSV) ≥230 cm/s corresponds to a ≥70% ICA stenosis, leading to the potential conclusion that asymptomatic patients with an ICA PSV ≥230 cm/s would benefit from CEA. Our goal was to determine the natural history stroke risk of asymptomatic patients who might have undergone CEA based on consensus statement PSV of ≥230 cm/s but instead were treated medically based on more conservative CDUS imaging criteria...
February 9, 2017: Journal of Vascular Surgery
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