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Asymptomatic carotid stenosis

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https://www.readbyqxmd.com/read/28438895/the-casper-carotid-artery-stent-a-unique-all-metal-micromesh-stent-designed-to-prevent-embolic-release
#1
Orlando Diaz, Gloria Lopez, John O F Roehm, Ginna De la Rosa, Fernando Orozco, Rafael Almeida
BACKGROUND: Stroke due to the release of embolic debris during the placement of a stent to correct carotid artery stenosis is a constant procedural and peri-procedural threat. The new all metal Casper stent has been created with two layers of nitinol, the inner layer of which has pores diminutive enough to prevent embolic release. OBJECTIVE: To evaluate the safety, effectiveness, and utility of the double layer nitinol Casper carotid artery stent in the treatment of patients with severe carotid artery stenosis...
April 24, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28431600/assessment-of-on-treatment-platelet-reactivity-and-relationship-with-cerebral-micro-embolic-signals-in-asymptomatic-and-symptomatic-carotid-stenosis
#2
Justin A Kinsella, W Oliver Tobin, Sean Tierney, Timothy M Feeley, Bridget Egan, Tara Coughlan, D Ronan Collins, Desmond O'Neill, Joseph A Harbison, Colin P Doherty, Prakash Madhavan, Dermot J Moore, Sean M O'Neill, Mary-Paula Colgan, Maher Saqqur, Raymond P Murphy, Niamh Moran, George Hamilton, Dominick J H McCabe
INTRODUCTION: The relationship between on-treatment platelet reactivity and cerebral micro-embolic signals (MES) is unknown, and has not been previously simultaneously assessed in asymptomatic and symptomatic carotid stenosis patients. METHODS: Consecutive eligible patients with ≥50% asymptomatic or recently symptomatic carotid stenosis (≤4weeks following TIA/ischaemic stroke) were recruited to this pilot study. Symptomatic patients were followed up to the 'late' phase (≥3months) following symptom onset or carotid intervention; longitudinal data were analysed from symptomatic patients with data available at both time-points...
May 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/28380656/early-results-of-surgical-simultaneous-therapy-for-significant-carotid-artery-stenosis-and-heart-disease
#3
Marc Irqsusi, Alessandro Vannucchi, Julius Beckers, Stefan Kasseckert, Stefan Waldhans, Sebastian Vogt, Rainer G H Moosdorf
Background The purpose of this single-center, retrospective study was to review the early outcome with defined endpoints of myocardial infarction, brain injury, and death after coronary bypass grafting and simultaneous carotid endarterectomy with or without combined valve replacement. Methods During the preoperative investigation 52 (44 males, 8 females) patients were examined by cardiac catheterization within the scope of their coronary status. In addition, all patients underwent echocardiography, CT angiography of the supra-aortic vessels, and full description of their neurologic status...
April 5, 2017: Thoracic and Cardiovascular Surgeon
https://www.readbyqxmd.com/read/28379549/asymptomatic-extracranial-vertebral-artery-disease-in-patients-with-internal-carotid-artery-stenosis
#4
Adnan I Qureshi, Saqib A Chaudhry, Henning Eckstein, Olav Jansen, Peter A Ringleb
BACKGROUND: Extracranial vertebral artery disease is seen in patients with internal carotid artery stenosis, although the clinical significance is not well understood. OBJECTIVE: To determine the prevalence and natural history of extracranial vertebral artery disease in patients with recently symptomatic internal carotid artery stenosis. METHODS: We analyzed data collected for patients with recently symptomatic internal carotid artery stenosis in the Stent-Protected Angioplasty vs Carotid Endarterectomy trial...
March 30, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28359719/regional-variation-in-patient-selection-and-treatment-for-carotid-artery-disease-in-the-vascular-quality-initiative
#5
Katie E Shean, John C McCallum, Peter A Soden, Sarah E Deery, Joseph R Schneider, Brian W Nolan, Caron B Rockman, Marc L Schermerhorn
OBJECTIVE: Previous studies involving large administrative data sets have revealed regional variation in the demographics of patients selected for carotid endarterectomy (CEA) and carotid artery stenting (CAS) but lacked clinical granularity. This study aimed to evaluate regional variation in patient selection and operative technique for carotid artery revascularization using a detailed clinical registry. METHODS: All patients who underwent CEA or CAS from 2009 to 2015 were identified in the Vascular Quality Initiative (VQI)...
March 27, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28344618/patient-and-lesion-tailored-algorithm-of-endovascular-treatment-for-arterial-occlusive-disease-of-extracranial-arteries-supplying-the-brain-safety-of-the-treatment-at-30-day-follow-up
#6
Paweł Latacz, Marian Simka, Paweł Brzegowy, Piotr Janas, Marek Kazibudzki, Piotr Pieniążek, Andrzej Ochała, Tadeusz Popiela, Tomasz Mrowiecki
INTRODUCTION: Although surgical endarterectomy remains the treatment of choice for carotid artery stenosis, stenting plays an important role as an alternative treatment modality, especially in high-risk patients. The actual safety profile associated with stenting procedures is probably better than that reported by randomized controlled trials. AIM: To assess the safety of stent implantations in extracranial arteries supplying the brain, and also to identify risk factors associated with this procedure...
2017: Postępy W Kardiologii Interwencyjnej, Advances in Interventional Cardiology
https://www.readbyqxmd.com/read/28318997/diastolic-blood-pressure-is-a-risk-factor-for-peri-procedural-stroke-following-carotid-endarterectomy-in-asymptomatic-patients
#7
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
#8
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
#9
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
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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...
May 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28274754/noninvasive-characterization-of-carotid-plaque-strain
#16
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
#17
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
#18
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...
April 3, 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
#19
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
#20
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
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