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Asymptomatic carotid stenosis

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https://www.readbyqxmd.com/read/28625670/carotid-occlusion-is-associated-with-more-frequent-neurovascular-events-than-moderately-severe-carotid-stenosis
#1
Matthew Janko, Ryan Moore, Ann H Kim, Andrew J Shevitz, Katherine L Morrow, David J Johnson, Vikram S Kashyap
OBJECTIVE: Asymptomatic internal carotid artery occlusion (CO) presents a clinical dilemma, and presently, the natural history, stroke risk, and optimal management remain ill defined. This study compared outcomes, including neurovascular events (NVEs) and health care costs, between patients with CO and patients with asymptomatic carotid artery stenosis (CS). METHODS: A prospectively maintained database was queried to identify patients with CO and CS with at least >50% carotid stenosis by duplex...
June 16, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28623378/carotid-stenting-in-neuroradiology-a%C3%A2-short-journey-from-the-past-to-current-debates
#2
REVIEW
Joachim Berkefeld, Marlies Wagner, Richard du Mesnil
After a period of stagnation due to negative results of randomized trials for patients with symptomatic stenosis, the relevance of carotid artery stenting (CAS) is increasing again. CAS has become an important and evidence-based part of interventional stroke treatment. Our ability to manage acute recanalization of carotid occlusions and other niche indications properly led some skeptical neurologists to trust in carotid intervention for elective cases as well. The evolution of CAS from initial euphoria to more realistic views under consideration of trial results and guidelines is reviewed...
June 16, 2017: Clinical Neuroradiology
https://www.readbyqxmd.com/read/28623117/open-heart-surgery-does-not-increase-the-incidence-of-ipsilateral-ischemic-stroke-in-patients-with-asymptomatic-severe-carotid-stenosis
#3
John E Castaldo, Hussam A Yacoub, Yuebing Li, Hope Kincaid, Donna Jenny
BACKGROUND AND PURPOSE: We evaluated the incidence of perioperative stroke following the institution's 2007 practice change of discontinuing combined carotid endarterectomy and open heart surgery (OHS) for patients with severe carotid stenosis. METHODS: In this retrospective cohort study, we compared 113 patients undergoing coronary artery bypass grafting, aortic valve replacement, or both from 2007 to 2011 with data collected from 2001 to 2006 from a similar group of patients...
June 13, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28603515/factors-influencing-decision-making-for-carotid-endarterectomy-versus-stenting-in-the-very-elderly
#4
REVIEW
Sung Hyuk Heo, Cheryl D Bushnell
As the population ages worldwide, the number of elderly patients with carotid stenosis is also increasing. There have been many large clinical trials comparing carotid endarterectomy (CAE) versus stenting, but the inclusion criteria (i.e., symptomatic or asymptomatic), stenting methods (i.e., protection device), and primary end point (i.e., the definition of myocardial infarction and follow-up period) were different between trials. Therefore, the interpretation of those results is difficult and requires attention...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28597323/stent-induced-flow-disturbances-in-the-ipsilateral-external-carotid-artery-following-internal-carotid-artery-stenting-a%C3%A2-temporary-cause-of-jaw-claudication
#5
Georgiana-Aura Giurgea, Markus Haumer, Irene Mlekusch, Schila Sabeti-Sandor, Petra Dick, Martin Schillinger, Erich Minar, Wolfgang Mlekusch
BACKGROUND: We hypothesize that stenting of the internal carotid artery can immediately impede blood flow to the external carotid artery by either plaque shift or stent coverage of the ostium, and thereby cause ischemic symptoms like ipsilateral jaw claudication. METHODS: Thirty-three patients with high-grade asymptomatic stenosis of the internal carotid artery who underwent endovascular treatment were examined by ultrasound of the external carotid artery and performed an exercise test by chewing chewing gum synchronously to an electronic metronome for 3 min...
June 9, 2017: Wiener Klinische Wochenschrift
https://www.readbyqxmd.com/read/28596038/predictors-of-30-day-postoperative-major-adverse-clinical-events-after-carotid-artery-stenting-an-analysis-of-the-procedure-targeted-american-college-of-surgeons-national-surgical-quality-improvement-program
#6
Kyla M Bennett, John R Hoch, John E Scarborough
BACKGROUND: Information about carotid artery stenting (CAS) is largely derived from clinical trials, consensus statements, and outcomes comparisons between CAS and carotid endarterectomy. Given these limitations, the goal of this study was to identify risk factors for adverse outcomes after CAS among hospitals participating in the CAS-targeted American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). METHODS: Our study sample consisted of patients from the 2012 to 2015 CAS-targeted ACS NSQIP data set...
June 5, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28583737/development-of-a-validated-model-to-predict-30-day-stroke-and-1-year-survival-after-carotid-endarterectomy-for-asymptomatic-stenosis-using-the-vascular-quality-initiative
#7
Randall R DeMartino, Benjamin S Brooke, Dan Neal, Adam W Beck, Mark F Conrad, Shipra Arya, Sapan Desai, Faisal Aziz, Patrick Ryan, Jack L Cronenwett, Larry W Kraiss
OBJECTIVE: Carotid endarterectomy (CEA) has been shown to be an effective treatment for patients with asymptomatic carotid artery stenosis when perioperative stroke rates are low and patients survive long enough to benefit from the intervention. Our objective was to develop and to validate a simple risk prediction model for 30-day stroke and 1-year mortality to guide optimal selection of patients for CEA. METHODS: Asymptomatic patients undergoing first-time elective CEA within the Vascular Quality Initiative (VQI) from 2010 to 2015 were selected...
June 2, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28577790/impact-of-provider-characteristics-on-outcomes-of-carotid-endarterectomy-for-asymptomatic-carotid-stenosis-in-new-york-state
#8
Andrew J Meltzer, Christopher Agrusa, Peter H Connolly, Darren B Schneider, Art Sedrakyan
OBJECTIVE: (s)The purpose of this study was to explore the impact of surgeon characteristics (including annual volume, specialty, and years in practice) on outcomes of carotid endarterectomy (CEA) for asymptomatic carotid atherosclerosis in New York State. METHODS: The New York Statewide Planning and Cooperation System (SPARCS) database was utilized to identify patients undergoing CEA from 2004-2011. Provider characteristics were determined by linkage to the New York Office of Professions and National Provider Identification databases...
May 31, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28575478/the-preservation-of-cognition-1-yr-after-carotid-endarterectomy-in-patients-with-prior-cognitive-decline
#9
Robert J Dempsey, Daren C Jackson, Stephanie M Wilbrand, Carol C Mitchell, Sara E Berman, Sterling C Johnson, Nirvedh H Meshram, Tomy Varghese, Bruce P Hermann
BACKGROUND: Vascular cognitive decline is critically important in the course of atherosclerosis and stroke. OBJECTIVE: To explore the hypothesis that carotid endarterectomy (CEA) by removing an unstable plaque may slow the course of vascular cognitive decline in both symptomatic and asymptomatic patients. METHODS: Patients with clinically significant (>60%) carotid stenosis were studied preop and 1 yr post-CEA for clinical symptoms, vascular cognitive decline, instability of carotid plaque-presence of microemboli, brain white matter changes, and medical risk factors...
June 1, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28560568/outcome-of-carotid-artery-stenting-in-the-hands-of-vascular-surgeons
#10
Carola Marie Wieker, S Demirel, N Attigah, M Hakimi, U Hinz, D Böckler
OBJECTIVES: To analyze the procedural and clinical outcomes of carotid artery stenting (CAS) in the hands of endovascular trained vascular surgeons. METHODS: Between April 2008 to May 2013, 1197 patients were treated for extracranial internal carotid artery (ICA) stenosis. The proportion of endovascular treated patients was 5.0% (CAS n = 60 vs. carotid endarterectomy (CEA) n = 1137). All patients in the CAS group (44 males, median age 70 years) were treated by two senior vascular surgeons experienced in endovascular methods...
May 30, 2017: Langenbeck's Archives of Surgery
https://www.readbyqxmd.com/read/28559178/investigation-into-drivers-of-cost-of-stenting-for-carotid-stenosis
#11
Lorenzo Rinaldo, Waleed Brinjikji, Harry Cloft, Randall R DeMartino, Giuseppe Lanzino
OBJECTIVE: We aimed to identify factors associated with cost of carotid artery stenting (CAS). METHODS: Patient and hospital characteristics affecting cost of admission for CAS were identified using the Vizient national database of hospital-reported outcomes. Patients who underwent CAS for either asymptomatic or symptomatic carotid stenosis were identified using surgical Medicare Severity-Diagnosis Related Groups and appropriate International Classification of Diseases, Ninth Revision and Tenth Revision codes...
May 27, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28539213/medical-management-of-asymptomatic-carotid-artery-stenosis
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
COMPARATIVE STUDY
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
#20
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
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