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Asymptomatic carotid stenosis

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https://www.readbyqxmd.com/read/28539213/medical-management-of-asymptomatic-carotid-artery-stenosis
#1
REVIEW
Aaron W Aday, Joshua A Beckman
Carotid artery atherosclerosis is a major risk factor for both stroke and cardiovascular disease. Appropriate management of asymptomatic patients with carotid artery stenosis (CAS) remains unclear. Although several randomized clinical trials support revascularization in asymptomatic patients with severe CAS to reduce stroke risk, the participants in these trials did not receive optimal medical therapy (OMT) by today's standards. For many individuals, medical therapy may provide excellent risk reduction without the periprocedural risk of endarterectomy or stenting...
May 21, 2017: Progress in Cardiovascular Diseases
https://www.readbyqxmd.com/read/28514842/gender-difference-in-radiotherapy-induced-carotid-stenosis
#2
Y Yang, W Yang, T J Wang
Radiotherapy (RT) is often the first choice of treatment for cancer of the larynx. Studies have shown that the incidence of carotid stenosis (CS) after radiotherapy of laryngeal cancer is increasing, and that gender difference in radiotherapy-induced side effects exist. Thus, we examined the gender difference in the incidence of CS and the impact of microinflammatory factors after radiotherapy. We reported this study on patients who received radiotherapy as part of the treatment for laryngeal cancer in the Jilin Province in China...
June 30, 2017: Journal of Biological Regulators and Homeostatic Agents
https://www.readbyqxmd.com/read/28513115/endarterectomy-or-stenting-in-severe-asymptomatic-carotid-stenosis
#3
Dallit Mannheim, Batla Falah, Ron Karmeli
BACKGROUND: Stroke is a major cause of death in the western world, and carotid endarterectomy has been shown to be effective in treating both symptomatic and asymptomatic carotid stenosis. Carotid stenting is a relatively new form of treatment for carotid stenosis and few studies have looked specifically at asymptomatic patients. OBJECTIVES: To retrospectively examine short- and long-term results in the treatment of asymptomatic carotid artery stenosis with surgery or stenting...
May 2017: Israel Medical Association Journal: IMAJ
https://www.readbyqxmd.com/read/28502543/the-association-of-carotid-revascularization-endarterectomy-versus-stent-trial-crest-and-centers-for-medicare-and-medicaid-services-carotid-guideline-publication-on-utilization-and-outcomes-of-carotid-stenting-among-high-risk-patients
#4
Gregory G Salzler, Alik Farber, Denis V Rybin, Gheorghe Doros, Jeffrey J Siracuse, Mohammad H Eslami
OBJECTIVE: Since the 2004 approval by the United States Food and Drug Administration of carotid artery stenting (CAS), there have been two seminal publications about CAS reimbursement (Centers for Medicare and Medicaid Services guidelines; 2008) and clinical outcomes (Carotid Revascularization Endarterectomy versus Stent Trial [CREST]; 2010). We explored the association between these publications and national trends in CAS use among high-risk symptomatic patients. METHODS: The most recent congruent data sets of the Nationwide Inpatient Sample (NIS) were queried for patients undergoing carotid revascularization...
May 11, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28500300/alterations-of-cerebral-perfusion-in-asymptomatic-internal-carotid-artery-steno-occlusive-disease
#5
Ya-Fang Chen, Sung-Chun Tang, Wen-Chau Wu, Hsien-Li Kao, Yen-Shu Kuo, Shun-Chung Yang
Patients with asymptomatic occlusion in the internal carotid arteries (ICA) have been shown to have a better preserved hemodynamic status of the brain as compared to patients with symptoms. This study was aimed to explore the cerebral perfusion alterations in asymptomatic patients using multi-parametric arterial spin-labeling (ASL) magnetic resonance (MR) imaging. Forty-two patients diagnosed with asymptomatic ICA stenosis/occlusion were prospectively included and divided into high-grade (ultrasonographic stenosis ≥70%, N = 20) and low-grade groups (N = 22)...
May 12, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28493931/asymptomatic-carotid-artery-stenosis-and-retinal-nerve-fiber-layer-thickness-a-community-based-observational-study
#6
Dandan Wang, Yang Li, Yong Zhou, Cheng Jin, Qi Zhao, Anxin Wang, Shouling Wu, Wen Bin Wei, Xingquan Zhao, Jost B Jonas
PURPOSE: To examine whether an abnormally thin retinal nerve fiber layer (RNFL) is associated with cerebrovascular insufficiency. DESIGN: Community-based study. METHODS: The Asymptomatic Polyvascular Abnormalities in Community Study included Chinese aged 40+ years and without histories of cerebrovascular incidents or coronary heart disease. Using transcranial Doppler and carotid duplex ultrasound examination, we assessed presence and degree of an intracranial arterial stenosis (ICAS) and extracranial carotid arterial stenosis (ECAS) and we measured the RNFL thickness by spectral-domain optical coherence tomography...
2017: PloS One
https://www.readbyqxmd.com/read/28491467/association-between-asymptomatic-unilateral-internal-carotid-artery-stenosis-and-electrophysiological-function-of-the-retina-and-optic-nerve
#7
Anna Machalińska, Aleksandra Kowalska-Budek, Miłosz Piotr Kawa, Arkadiusz Kazimierczak, Krzysztof Safranow, Marta Kirkiewicz, Grażyna Wilk, Wojciech Lubiński, Piotr Gutowski, Bogusław Machaliński
Purpose. This study was designed to assess retinal and optic nerve bioelectrical function in patients with unilateral asymptomatic but hemodynamically significant internal carotid artery stenosis (ICAS). Methods. Forty-two subjects with a diagnosis of unilateral ICAS and 34 controls were analyzed. Full-field electroretinogram (ERG), pattern electroretinogram (PERG), and pattern visual-evoked potentials, as well as optical coherence tomography and ophthalmological examination, were performed. Data analysis included eyes ipsilateral to ICAS (EIS) and eyes contralateral to ICAS (ECS)...
2017: Journal of Ophthalmology
https://www.readbyqxmd.com/read/28487317/head-to-head-comparison-of-inflammation-and-neovascularization-in-human-carotid-plaques-implications-for-the-imaging-of-vulnerable-plaques
#8
Fabian Demeure, Caroline Bouzin, Véronique Roelants, Anne Bol, Robert Verhelst, Parla Astarci, Bernhard L Gerber, Anne-Catherine Pouleur, Agnès Pasquet, Christophe de Meester, Jean-Louis J Vanoverschelde, David Vancraeynest
BACKGROUND: Inflammation and intraplaque neovascularization are acknowledged to be 2 features of plaque vulnerability, although their temporal expression and their respective value in predicting clinical events are poorly understood. To determine their respective temporal associations, we conducted a comprehensive assessment of inflammation and intraplaque neovascularization in the carotid plaque of symptomatic and asymptomatic patients. METHODS AND RESULTS: Thirty patients with severe carotid stenosis underwent (18)F-fluorodeoxyglucose-positron emission tomography/computed tomographic imaging...
May 2017: Circulation. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28483619/bilateral-internal-carotid-arteries-occlusion-external-carotid-arteries-stenosis-and-vertebral-arteries-kinking-may-it-be-asymptomatic
#9
Nikola Fatic, Usman Jaffer, Saicic Ivana, Globarevic-Vukcevic Gordana, Dragan Markovic, Dusan Kostic, Lazar Davidovic
The clinical spectrum of internal carotid artery occlusion ranges from being a completely asymptomatic occlusion to a devastating stroke or death. The prevalence of asymptomatic internal carotid artery occlusion is unknown, particularly for bilateral occlusion. The distal branches of the external carotid artery anastomose with distal branches of the internal carotid artery providing important sources of collateral circulation to the brain. Stenosis of the external carotid artery with ipsilateral/bilateral internal occlusion may result in ischemic sequelae...
May 5, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28462683/carotid-revascularization-and-medical-management-for-asymptomatic-carotid-stenosis-protocol-of-the-crest-2-clinical-trials
#10
Virginia J Howard, James F Meschia, Brajesh K Lal, Tanya N Turan, Gary S Roubin, Robert D Brown, Jenifer H Voeks, Kevin M Barrett, Bart M Demaerschalk, John Huston, Ronald M Lazar, Wesley S Moore, Virginia G Wadley, Seemant Chaturvedi, Claudia S Moy, Marc Chimowitz, George Howard, Thomas G Brott
Rationale Trials conducted decades ago demonstrated that carotid endarterectomy by skilled surgeons reduced stroke risk in asymptomatic patients. Developments in carotid stenting and improvements in medical prevention of stroke caused by atherothrombotic disease challenge understanding of the benefits of revascularization. Aim Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST-2) will test whether carotid endarterectomy or carotid stenting plus contemporary intensive medical therapy is superior to intensive medical therapy alone in the primary prevention of stroke in patients with high-grade asymptomatic carotid stenosis...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28461597/case-of-asymptomatic-carotid-artery-stenosis-in-a-hypertensive-patient
#11
David Calvet, Laurence Amar, Gian Paolo Rossi, Stéphane Laurent, Anna F Dominiczak, Guillaume Turc, Garry Jennings, Tomasz Guzik, Rhian M Touyz
No abstract text is available yet for this article.
June 2017: Hypertension
https://www.readbyqxmd.com/read/28446654/optimal-management-of-patients-with-asymptomatic-carotid-stenosis
#12
EDITORIAL
Robert M Starke
No abstract text is available yet for this article.
April 26, 2017: Neurology
https://www.readbyqxmd.com/read/28446652/asymptomatic-carotid-stenosis-medicine-alone-or-combined-with-carotid-revascularization
#13
REVIEW
Donald V Heck, Gary S Roubin, Kenneth G Rosenfield, William A Gray, Christopher J White, Tudor G Jovin, Jon S Matsumura, Brajesh K Lal, Barry T Katzen, Guilherme Dabus, Brian T Jankowitz, Thomas G Brott
Two positive randomized trials established carotid endarterectomy (CEA) as a superior treatment to medical management alone for the treatment of asymptomatic carotid artery stenosis. However, advances in medical therapy have led to an active and spirited debate about the best treatment for asymptomatic carotid stenosis. The Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis (CREST 2) trial aims to better define the best treatment for the average patient with severe asymptomatic carotid stenosis...
April 26, 2017: Neurology
https://www.readbyqxmd.com/read/28446650/asymptomatic-carotid-stenosis-why-a-moratorium-is-needed-on-intervention-outside-clinical-trials
#14
EDITORIAL
J David Spence
No abstract text is available yet for this article.
April 26, 2017: Neurology
https://www.readbyqxmd.com/read/28446026/medical-therapy-before-carotid-endarterectomy
#15
Daniele Bissacco, Michele Carmo, Iacopo Barbetta, Raffaello Dallatana, Piergiorgio G Settembrini
We evaluated the evolution of chronic medical therapy in patients admitted for carotid endarterectomy (CEA) over a 13-year period and to analyze the difference in medical treatment between symptomatic and asymptomatic patients. A retrospective study was conducted on patients treated between 2002 and 2015. The use of antiplatelets (acetylsalicylic acid [ASA], ticlopidine, and clopidogrel), oral anticoagulant therapy (OAT), statins and antihypertensives (angiotensin-converting enzyme inhibitors [ACE-I]/angiotensin receptor blockers [ARBs], β-blockers [BB]) administration was evaluated...
January 1, 2017: Angiology
https://www.readbyqxmd.com/read/28438895/the-casper-carotid-artery-stent-a-unique-all-metal-micromesh-stent-designed-to-prevent-embolic-release
#16
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
#17
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
#18
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
#19
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
#20
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
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