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Asymptomatic carotid stenosis

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https://www.readbyqxmd.com/read/28727356/-management-of-carotid-artery-stenosis
#1
Francesco Puccinelli, Marco Roffi, Nicolas Murith, Roman Sztajzel
Carotid artery atherosclerosis remains one of the major causes of stroke. The efficacy of carotid artery recanalization has already been established and is considered significant for symptomatic stenosis >70% and moderate for stenosis between 50-69 %. Regarding asymptomatic stenosis, carotid artery recanalization should be reserved for carefully selected patients with a stenosis between 70-90 % and an estimated procedural risk at less than 3 %. Two therapeutic options are currently available : angioplasty with stent placement and endarterectomy...
April 26, 2017: Revue Médicale Suisse
https://www.readbyqxmd.com/read/28726649/lipoprotein-associated-phospholipase-a2-as-a-marker-of-vulnerable-atherosclerotic-plaque-in-patients-with-internal-carotid-artery-stenosis
#2
P Štefanič, I Kopolovets, Z Hertelyová, Š Tóth, M Frankovičová
The aim of this study was to compare the concentration of inflammatory vascular markers and morphological structure of atherosclerotic plaque in symptomatic and asymptomatic patients with the stenosis of internal carotid artery (ICA). The research was carried out in 70 patients with hemodynamically significant stenosis of ICA out of which 40 (57%) were asymptomatic patients and 30 (43%) were symptomatic patients, of which 20 patients (66%) have had a stroke, or transient ischemic attack (TIA), 10 patients (33%)...
June 2017: Georgian Medical News
https://www.readbyqxmd.com/read/28724881/effect-of-carotid-endarterectomy-on-retinal-function-in-asymptomatic-patients-with-hemodynamically-significant-carotid-artery-stenosis
#3
Anna Machalińska, Aleksandra Kowalska-Budek, Miłosz Piotr Kawa, Arkadiusz Kazimierczak, Krzysztof Safranow, Marta Kirkiewicz, Paweł Rynio, Grażyna Wilk, Wojciech Lubiński, Piotr Gutowski, Bogusław Machaliński
INTRODUCTION    The corrective effect of carotid endarterectomy (CEA) on disturbed ophthalmic artery flow in patients with a significant internal carotid artery stenosis (ICAS) presenting with ocular ischemic syndrome (i.e., symptomatic patients) is well established. However, no clear evidence exists regarding the efficacy of CEA for improvement of neuro-retinal function in patients without symptoms of ocular ischemic syndrome. OBJECTIVES    We determined the effects of CEA on retinal function in asymptomatic patients with hemodynamically significant internal carotid artery stenosis...
July 19, 2017: Polish Archives of Internal Medicine
https://www.readbyqxmd.com/read/28720076/prevalence-and-risk-factors-of-intracranial-and-extracranial-artery-stenosis-in-asymptomatic-rural-residents-of-13-villages-in-china
#4
Haiqiang Jin, Qing Peng, Ding Nan, Pu Lv, Ran Liu, Wei Sun, Yuming Teng, Yuanyuan Liu, Chenghe Fan, Haiying Xing, Ke Xu, Yining Huang
BACKGROUND: The present study aimed to investigate the prevalence and risk factors for extracranial carotid artery stenosis (ECAS) and intracranial carotid artery stenosis (ICAS) simultaneously in asymptomatic Chinese pure rural population. METHODS: We analyzed 2589 asymptomatic subjects aged over 30 yr. by ultrasonography and transcranial Doppler simultaneously in 13 isolated villages by door-to-door investigation. Both ECAS and ICAS were defined as more than 50% stenosis...
July 18, 2017: BMC Neurology
https://www.readbyqxmd.com/read/28716984/the-risk-of-ischemic-events-increased-in-patients-with-asymptomatic-carotid-stenosis-with-decreased-cerebrovascular-reserve
#5
Shulan Liu, Jing Cai, Fugui Ge, Wei Yue
Identifying high-risk patients with asymptomatic carotid stenosis (ACS) is necessary regardless of whether intensive medical therapy or aggressive treatment is applied. In order to assess the relationship between cerebrovascular reserve (CVR) measured by perfusion CT with inhalation of CO2 and the risk of ischemic events in ACS, this long-term follow-up study was conducted. Forty-five patients with ACS who underwent the examination of CVR measured by perfusion CT with inhalation of CO2 were collected and followed-up for at least 5 years...
July 17, 2017: Journal of Investigative Medicine: the Official Publication of the American Federation for Clinical Research
https://www.readbyqxmd.com/read/28716303/early-results-of-endovascular-treatment-of-patients-with-bilateral-stenoses-of-the-internal-carotid-arteries-using-proximal-protection-systems-at-30-day-follow-up
#6
Paweł Latacz, Marian Simka, Tadeusz Popiela, Marek Kazibudzki, Tomasz Mrowiecki
BACKGROUND: Although surgical endarterectomy remains the treatment of choice for carotid artery stenosis, carotid artery stenting (CAS) with use of proximal protection systems (PPS) plays an very important role as alternative treatment modality, especially in patients with critical, symptomatic lesions. This study was single-centre study to evaluate the technical and clinical success of proximal protection devices as the first choice for embolic protection in symptomatic and asymptomatic carotid stenosis in patients with bilateral, advanced lesions of carotid arteries (bilateral stenoses or stenosis and occlusion)...
July 8, 2017: Neurologia i Neurochirurgia Polska
https://www.readbyqxmd.com/read/28712815/asymptomatic-carotid-stenosis-is-associated-with-cognitive%C3%A2-impairment
#7
Brajesh K Lal, Moira C Dux, Siddhartha Sikdar, Carly Goldstein, Amir A Khan, John Yokemick, Limin Zhao
BACKGROUND: Cerebrovascular risk factors (eg, hypertension, coronary artery disease) and stroke can lead to vascular cognitive impairment. The Asymptomatic Carotid Stenosis and Cognitive Function study evaluated the isolated impact of asymptomatic carotid stenosis (no prior ipsilateral or contralateral stroke or transient ischemic attack) on cognitive function. Cerebrovascular hemodynamic and carotid plaque characteristics were analyzed to elucidate potential mechanisms affecting cognition...
July 13, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28697713/an-update-of-the-italian-stroke-organization-stroke-prevention-awareness-diffusion-group-guidelines-on-carotid-endarterectomy-and-stenting-a-personalized-medicine-approach
#8
Gaetano Lanza, Carlo Setacci, Stefano Ricci, Patrizio Castelli, Alberto Cremonesi, Jessica Lanza, Claudio Novali, Carlo Pratesi, Paola Santalucia, Francesco Speziale, Augusto Zaninelli, Gian Franco Gensini
Although proof-based medicine has generated much valid evidence for the drawing up of guidelines and recommendations for best clinical practice in symptomatic and asymptomatic carotid stenosis, whether and when it is better to employ endarterectomy or stenting as the intervention of choice still remain matters of debate. Moreover, guidelines have been targeted up to now to the 'representative' patient, as resulting from the statistical analyses of the studies conducted on the safety and efficacy of both interventions as well as on medical therapy alone...
July 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28689200/optimal-medical-management-reduces-risk-of-disease-progression-and-ischemic-events-in-asymptomatic-carotid-stenosis-patients-a-long-term-follow-up-study
#9
Zubair Shah, Reza Masoomi, Rashmi Thapa, Mashhood Wani, John Chen, Buddhadeb Dawn, Marilyn Rymer, Kamal Gupta
BACKGROUND AND PURPOSE: To assess the effect of optimal medical management including atherosclerotic risk factor control on ischemic stroke (IS), transient ischemic attack (TIA), carotid revascularization (CRV), and progression of severity of carotid stenosis (PSCS) in patients with asymptomatic carotid artery stenosis (ACAS). METHODS: We conducted a retrospective analysis of patients with ACAS (who had at least 3 serial carotid duplex ultrasounds) for incidence of IS, TIA, and PSCS...
July 8, 2017: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/28688468/evaluation-and-management-of-atherosclerotic-carotid-stenosis
#10
REVIEW
James F Meschia, James P Klaas, Robert D Brown, Thomas G Brott
Medical therapies for the prevention of stroke have advanced considerably in the past several years. There can also be a role for mechanical restoration of the lumen by endarterectomy or stenting in selected patients with high-grade atherosclerotic stenosis of the extracranial carotid artery. Endarterectomy is generally recommended for patients with high-grade symptomatic carotid stenosis. Stenting is considered an option for patients at high risk of complications with endarterectomy. Whether revascularization is better than contemporary medical therapy for asymptomatic extracranial carotid stenosis is a subject of several ongoing randomized clinical trials in the United States and internationally...
July 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/28679848/carotid-stenting-versus-endarterectomy-for-asymptomatic-carotid-artery-stenosis-a-systematic-review-and-meta-analysis
#11
Paola Moresoli, Bettina Habib, Pauline Reynier, Matthew H Secrest, Mark J Eisenberg, Kristian B Filion
BACKGROUND AND PURPOSE: There is no consensus on the comparative efficacy and safety of carotid artery stenting (CAS) versus carotid endarterectomy (CEA) in patients with asymptomatic carotid artery stenosis. To evaluate CAS versus CEA in asymptomatic patients, we conducted a systematic review and meta-analysis of randomized controlled trials. METHODS: We systematically searched EMBASE, PubMed, MEDLINE, and the Cochrane Library for randomized controlled trials comparing CAS to CEA in asymptomatic patients using a pre-specified protocol...
July 5, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28679355/oxidative-injury-associated-with-stenting-of-asymptomatic-carotid-artery-stenosis
#12
Konstantinos G Moulakakis
No abstract text is available yet for this article.
July 2017: VASA. Zeitschrift Für Gefässkrankheiten
https://www.readbyqxmd.com/read/28675103/carotid-artery-plaques-carotid-intima-media-thickness-and-risk-of-cardiovascular-events-and-all-cause-death-in-older-adults-a-5-year-prospective-community-based-study
#13
Yanlei Zhang, Xianghua Fang, Yang Hua, Zhe Tang, Shaochen Guan, Xiaoguang Wu, Hongjun Liu, Beibei Liu, Chunxiu Wang, Zhongying Zhang, Xiang Gu, Chengbei Hou, Chunxiao Liu
We assessed the effect of asymptomatic carotid atherosclerosis (CAS) on the development of cardiovascular diseases (CVDs) in a community-based population aged ≥55 years in China. A total of 1376 residents underwent CAS assessment by ultrasonography in July 2009. New CVD events, including stroke and coronary heart events, were collected at the follow-up survey at the end of 2014. After adjusting for baseline demographic characteristics and traditional CVD risk factors, the risk of CVD in patients with minimal CAS (mean common carotid artery intima-media thickness [CCA-IMT] ≥1 mm and no plaques), nonstenotic plaques (carotid stenosis <50%), and stenotic plaques (carotid stenosis ≥50%) was 0...
January 1, 2017: Angiology
https://www.readbyqxmd.com/read/28672747/ngal-and-mmp-9-ngal-as-biomarkers-of-plaque-vulnerability-and-targets-of-statins-in-patients-with-carotid-atherosclerosis
#14
Wolf Eilenberg, Stefan Stojkovic, Alexandra Kaider, Nicolas Kozakowski, Christoph M Domenig, Christopher Burghuber, Josif Nanobachvili, Kurt Huber, Markus Klinger, Christoph Neumayer, Ihor Huk, Johann Wojta, Svitlana Demyanets
BACKGROUND: Neutrophil gelatinase associated lipocalin (NGAL) is expressed in atherosclerotic lesions and was recently implicated in the pathogenesis of cardiovascular pathologies. Statins are known to exert stabilizing effects on atherosclerotic plaque. The aims of our study were (1) to investigate the association of serum NGAL and metalloproteinase (MMP)-9/NGAL complex with the vulnerability of the atherosclerotic plaque, and (2) to reveal the effects of statin treatment on circulating NGAL and MMP-9/NGAL levels in patients with carotid artery stenosis...
June 26, 2017: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/28659428/real-world-experience-of-treatment-decision-making-in-carotid-stenosis-in-a-neurovascular-board
#15
David Leander Rimmele, Axel Larena-Avellaneda, Anna C Alegiani, Michael Rosenkranz, Nils Ole Schmidt, Jan Regelsberger, Friedhelm C Hummel, Tim Magnus, Eike Sebastian Debus, Jens Fiehler, Christian Gerloff, Götz Thomalla
OBJECTIVE: To describe our experience with consensus-based decision-making for treatment of internal carotid artery (ICA) stenosis by neurologists, interventional neuroradiologists, vascular surgeons, and neurosurgeons in a multidisciplinary neurovascular board and to study adherence to treatment recommendations in the context of uncertainty with respect to the best treatment option. METHODS: We established a multidisciplinary neurovascular board meeting twice a week with structured documentation of consensus decisions...
June 28, 2017: Neurology
https://www.readbyqxmd.com/read/28655552/the-impact-of-contralateral-carotid-artery-stenosis-on-outcomes-after-carotid-endarterectomy
#16
Alexander B Pothof, Peter A Soden, Margriet Fokkema, Sara L Zettervall, Sarah E Deery, Thomas C F Bodewes, Gert J de Borst, Marc L Schermerhorn
OBJECTIVE: Patients with contralateral carotid occlusion (CCO) have been excluded from randomized clinical trials because of a deemed high risk for adverse neurologic outcomes with carotid endarterectomy (CEA). Evidence for this rationale is limited and conflicting. Therefore, we aimed to compare outcomes after CEA between patients with and without CCO and varying degrees of contralateral carotid stenosis (CCS). METHODS: We identified patients undergoing CEA from 2003 to 2015 in the Vascular Study Group of New England (VSGNE) registry...
June 24, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28652952/fibromuscular-dysplasia-with-spontaneous-coronary-artery-disease-presenting-as-acute-myocardial-infarction
#17
Ali Farooq, Waseem Amjad, Ata Ur Rahim Bajwa, Hassaan Yasin, Rizwan Ali, Muhammad Pervaiz
A 40-year-old female presented to a rural hospital with crushing substernal chest pain. An initial electrocardiogram showed ST elevation in lead II and aVF with elevated troponin I. She was immediately transferred to a tertiary care hospital. An emergent coronary angiogram did not show any significant coronary artery disease. On the second day, the patient experienced recurrence of severe chest pain with ST elevations in leads I, aVL, V5-V6, ST depressions in V1-V3, T-wave inversion over V2-V5. The troponin I level increased to > 40 ng/ml (normal 0...
May 23, 2017: Curēus
https://www.readbyqxmd.com/read/28651865/pre-operative-carotid-plaque-echolucency-assessment-has-no-predictive-value-for-long-term-risk-of-stroke-or-cardiovascular-death-in-patients-undergoing-carotid-endarterectomy
#18
D de Waard, G J de Borst, R Bulbulia, H Pan, A Halliday
INTRODUCTION: In patients with carotid stenosis receiving medical treatment, carotid plaque echolucency has been thought to predict risk of future stroke and of other cardiovascular events. This study evaluated the prognostic value of pre-operative plaque echolucency for future stroke and cardiovascular death in patients undergoing carotid endarterectomy in the first Asymptomatic Carotid Surgery Trial (ACST-1). METHODS: In ACST-1, 1832/3120 patients underwent carotid endarterectomy (CEA), of whom 894 had visual echolucency assessment according to the Gray-Weale classification...
June 23, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28646330/-imaging-of-vessels-supplying-the-brain
#19
REVIEW
S M Schellong, N Abolmaali, B Voigts, C Stelzner
Nowadays, several technically validated modalities are available for imaging both the extracranial and intracranial segments of arteries supplying blood to the brain. In the acute stroke setting, computed tomography (CT) angiography is of utmost importance because it provides the key diagnostic criteria indicative for the use of catheter-based recanalization techniques. Ultrasound imaging of extracranial arteries is most suitable for detecting an underlying stenosis of the internal carotid artery (ICA) in patients with stroke, transient ischemic attacks (TIA), retinal vessel occlusion and amaurosis fugax...
June 23, 2017: Der Internist
https://www.readbyqxmd.com/read/28641848/the-use-of-embolic-protection-devices-is-associated-with-a-lower-stroke-and-death-rate-after-carotid-stenting
#20
Christoph Knappich, Andreas Kuehnl, Pavlos Tsantilas, Sofie Schmid, Thorben Breitkreuz, Michael Kallmayer, Alexander Zimmermann, Hans-Henning Eckstein
OBJECTIVES: The aim of this study was to analyze the association between intraprocedural and periprocedural variables and in-hospital stroke or death rate after carotid artery stenting. BACKGROUND: In Germany, all open surgical and endovascular procedures on the extracranial carotid artery must be documented in a statutory nationwide quality assurance database. METHODS: A total of 13,086 carotid artery stenting procedures for asymptomatic (63...
June 26, 2017: JACC. Cardiovascular Interventions
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