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Asymptomatic carotid stenosis

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https://www.readbyqxmd.com/read/29217492/the-potential-role-of-ideal-mri-for-identification-of-lipids-and-hemorrhage-in-carotid-artery-plaques
#1
Faisal Khosa, Rachel E Clough, Xiaoen Wang, Ananth J Madhuranthakam, Robert L Greenman
Hemorrhage and lipid deposits contribute to instability in atherosclerotic plaques. Unstable carotid artery plaques can lead to cerebral ischemic events. While MRI studies have shown the ability to identify plaque components, the identification of hemorrhage and lipids has proven to be problematic. The purpose of this study was to quantitatively evaluate the potential of the MRI fat/water separation method known as iterative decomposition of water and fat with echo asymmetry and least squares estimation (IDEAL) to complement and improve existing methods for the identification of hemorrhage and lipids in carotid artery plaques...
December 4, 2017: Magnetic Resonance Imaging
https://www.readbyqxmd.com/read/29217437/carotid-endarterectomy-performed-before-the-weekend-is-associated-with-increased-length-of-stay
#2
Thomas W Cheng, Alik Farber, Jeffrey A Kalish, Douglas W Jones, Myriam Castagne, Denis Rybin, Stephen J Raulli, Jeffrey J Siracuse
OBJECTIVE: Length of stay (LOS) is commonly used to gauge hospital resource utilization and can affect hospital profit margin. Other fields of surgery have showed that operations performed close to the weekend have longer LOS and higher patient morbidity. Our goal was to investigate whether asymptomatic patients undergoing elective carotid endarterectomy (CEA) earlier in the week had a shorter LOS and improved clinical outcomes compared to those treated before the weekend. METHODS: The Vascular Quality Initiative (VQI) database was queried for elective weekday CEAs performed for asymptomatic carotid stenosis from 2005 to 2017...
December 4, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29196884/ultrasonographical-features-associated-with-progression-of-atherosclerosis-in-patients-with-moderate-internal-carotid-artery-stenosis
#3
Yumei Liu, Yang Hua, Ran Liu, Lili Wang, Chun Duan, Chen Ling, Xiaoguang Wu, Ovbiagele Bruce, Wuwei Feng
Carotid artery stenosis (CAS) is a leading cause of ischemic stroke. Plaque stabilization is a major management approach. Information about the ultrasonographical and clinical features associated with the progression of moderate internal carotid artery (ICA) stenosis (50-69%) could assist with prognostication and risk factor modifications. We evaluated 287 patients with moderate ICA stenosis (50-69%) and subsequently evaluated them at follow-up points at 12, 24, and 36 months. Patients were divided into three groups according to the degree of ICA stenosis: progression (70-99%, n = 48), stable (50-69%, n = 210), and regression (< 50%, n = 29)...
December 1, 2017: Translational Stroke Research
https://www.readbyqxmd.com/read/29192895/how-asymptomatic-is-asymptomatic-carotid-stenosis-resolving-fundamental-confusion-s-and-confusions-yet-to-be-resolved
#4
Piotr Musiałek, Iris Q Grunwald
No abstract text is available yet for this article.
November 30, 2017: Polish Archives of Internal Medicine
https://www.readbyqxmd.com/read/29169797/carotid-artery-disease-as-a-predictor-of-in-hospital-postoperative-stroke-after-coronary-artery-bypass-grafting-from-1999-to-2011
#5
Amol Mehta, Ravi Choxi, Thomas Gleason, Lawrence Wechsler, Tudor Jovin, Parthasarathy D Thirumala
BACKGROUND: In this study, the risk factors for stroke after coronary artery bypass grafting (CABG) were examined. In particular, the role of asymptomatic carotid artery stenosis (both unilateral and bilateral) as a predictor of in-hospital postoperative stroke was investigated. Finally, the trends surrounding in-hospital postoperative stroke from 1999 to 2011 also were examined. The purpose of the study was to appropriately identify patients at high risk for stroke after CABG and spark discussion about the perioperative management of such patients...
October 9, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29163956/eversion-endarterectomy-under-full-prasugrel-treatment
#6
Thomas Kotsis, Panagitsa Christoforou, Nikolaos Asaloumidis, Erifyli Argyra
The third-generation thienopyridine prasugrel has much stronger antiplatelet effect compared to other current antiplatelet inhibitors and exhibits practically zero resistance in healthy people. Prasugrel is used as a pre- and post-treatment in percutaneous coronary or neurovascular interventions with parallel aspirin regime. However, as there is a higher reported bleeding with intraluminal interventions and meticulous technique is recommended, there is nearly non-existent international experience of open surgery under full prasugrel treatment...
2017: SAGE Open Medical Case Reports
https://www.readbyqxmd.com/read/29163214/predictive-value-of-dynamic-cerebral-autoregulation-assessment-in-surgical-management-of-patients-with-high-grade-carotid-artery-stenosis
#7
Vladimir B Semenyutin, Gregory A Asaturyan, Anna A Nikiforova, Vugar A Aliev, Grigory K Panuntsev, Vadim B Iblyaminov, Alexander V Savello, Andreas Patzak
Dynamic cerebral autoregulation (DCA) capacity along with the degree of internal carotid artery (ICA) stenosis and characteristics of the plaque can also play an important role in selection of appropriate treatment strategy. This study aims to classify the patients with severe ICA stenosis according to preoperative state of DCA and to assess its dynamics after surgery. Thirty-five patients with severe ICA stenosis having different clinical type of disease underwent reconstructive surgery. DCA was assessed with transfer function analysis (TFA) by calculating phase shift (PS) between Mayer waves of blood flow velocity (BFV) and blood pressure (BP) before and after operation...
2017: Frontiers in Physiology
https://www.readbyqxmd.com/read/29153440/relationship-between-adamts4-and-carotid-atherosclerotic-plaque-vulnerability-in-humans
#8
Honglin Dong, Tian Du, Shyamal Premaratne, Cynthia X Zhao, Qinqin Tian, Yongjun Li, Sheng Yan, Wayne W Zhang
BACKGROUND: Rupture of atherosclerotic plaques and the resulting thrombosis are vital causes of clinical ischemic events. Recent studies have shown that ADAMTS4 (a disintegrin and metalloproteinase with thrombospondin motifs 4) is a pathogenic factor of plaque vulnerability in mice. However, the relationship between ADAMTS4 and carotid atherosclerotic vulnerable plaques in humans remains unclear. METHODS: Forty-eight carotid atherosclerotic plaque specimens were obtained from 48 carotid artery stenosis inpatients undergoing carotid endarterectomy...
November 15, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29143732/surgical-and-endovascular-treatment-of-extracranial-carotid-stenosis
#9
Hans-Henning Eckstein, Pavlos Tsantilas, Andreas Kühnl, Bernhard Haller, Thorben Breitkreuz, Alexander Zimmermann, Michael Kallmayer
BACKGROUND: Carotid endarterectomy (CEA) and carotid artery stenting (CAS) can be used to prevent stroke due to arteriosclerotic lesions of the carotid artery. In Germany, legally mandated quality assurance (QA) enables the evaluation of outcome quality after CEA and CAS performed under routine conditions. METHODS: We analyzed data on all elective CEA and CAS procedures performed over the periods 2009-2014 and 2012-2014, respectively. The endpoints of the study were the combined in-hospital stroke and death rate, stroke rate and mortality separately, local complications, and other complications...
October 27, 2017: Deutsches Ärzteblatt International
https://www.readbyqxmd.com/read/29143147/-esc-guidelines-2017-on-peripheral-arterial-diseases-summary-of-the-most-important-recommendations-and-innovations
#10
C Espinola-Klein
The current European Society of Cardiology (ESC) guidelines on peripheral arterial diseases include recommendations on diagnostics and treatment of atherosclerotic manifestations in peripheral arteries. Because of the high coincidence of atherosclerosis in different arterial territories, screening for other atherosclerotic lesions is necessary in patients with clinical symptoms in one vascular bed. Consistent treatment of cardiovascular risk factors is important in all patients with peripheral atherosclerosis...
November 15, 2017: Herz
https://www.readbyqxmd.com/read/29132880/rivaroxaban-with-or-without-aspirin-in-patients-with-stable-peripheral-or-carotid-artery-disease-an-international-randomised-double-blind-placebo-controlled-trial
#11
Sonia S Anand, Jackie Bosch, John W Eikelboom, Stuart J Connolly, Rafael Diaz, Peter Widimsky, Victor Aboyans, Marco Alings, Ajay K Kakkar, Katalin Keltai, Aldo P Maggioni, Basil S Lewis, Stefan Störk, Jun Zhu, Patricio Lopez-Jaramillo, Martin O'Donnell, Patrick J Commerford, Dragos Vinereanu, Nana Pogosova, Lars Ryden, Keith A A Fox, Deepak L Bhatt, Frank Misselwitz, John D Varigos, Thomas Vanassche, Alvaro A Avezum, Edmond Chen, Kelley Branch, Darryl P Leong, Shrikant I Bangdiwala, Robert G Hart, Salim Yusuf
BACKGROUND: Patients with peripheral artery disease have an increased risk of cardiovascular morbidity and mortality. Antiplatelet agents are widely used to reduce these complications. METHODS: This was a multicentre, double-blind, randomised placebo-controlled trial for which patients were recruited at 602 hospitals, clinics, or community practices from 33 countries across six continents. Eligible patients had a history of peripheral artery disease of the lower extremities (previous peripheral bypass surgery or angioplasty, limb or foot amputation, intermittent claudication with objective evidence of peripheral artery disease), of the carotid arteries (previous carotid artery revascularisation or asymptomatic carotid artery stenosis of at least 50%), or coronary artery disease with an ankle-brachial index of less than 0·90...
November 10, 2017: Lancet
https://www.readbyqxmd.com/read/29117272/risks-associated-with-primary-and-redo-carotid-endarterectomy-in-the-endovascular-era
#12
Isibor J Arhuidese, Muhammad Faateh, Besma J Nejim, Satinderjit Locham, Christopher J Abularrage, Mahmoud B Malas
Importance: Clinical experience suggests worse outcomes for redo carotid endarterectomy (CEA) relative to primary CEA. Objective quantification of the excess risk attributable to redo CEA in this era of proliferating endovascular therapy remains to be determined. Objective: To evaluate the risks of redo CEA relative to primary CEA. Design, Setting, and Participants: This study was a retrospective analysis of a prospective cohort of patients maintained by the Society for Vascular Surgery in the Vascular Quality Initiative between January 1, 2003, and April 30, 2016...
November 8, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/29103477/atherosclerotic-plaque-features-and-distribution-in-bilateral-carotid-arteries-of-asymptomatic-elderly-population-a-3d-multicontrast-mr-vessel-wall-imaging-study
#13
Ying Cai, Le He, Chun Yuan, Huijun Chen, Qiang Zhang, Rui Li, Cheng Li, Xihai Zhao
PURPOSE: This study sought to investigate the characteristics of morphology, compositions and distribution of carotid atherosclerotic plaques in asymptomatic elderly population using three dimensional (3D) multicontrast magnetic resonance vessel wall imaging. MATERIALS AND METHODS: 146 asymptomatic elderly subjects (≥60years) were recruited and underwent 3D multicontrast MR vessel wall imaging for bilateral carotid arteries on a 3.0T MR scanner. The presence of carotid atherosclerotic plaque was determined and the stenosis was measured...
November 2017: European Journal of Radiology
https://www.readbyqxmd.com/read/29101839/community-based-statins-and-advanced-carotid-plaque-role-of-cd163-positive-macrophages-in-lipoprotein-associated-phospholipase-a2-activity-in-atherosclerotic-plaque
#14
Fumiyuki Otsuka, XiaoQing Zhao, Hugh H Trout, Ye Qiao, Bruce A Wasserman, Masataka Nakano, Colin H Macphee, Martin Brandt, Sue Krug-Gourley, Liang Guo, Elena R Ladich, Qi Cheng, Harry R Davis, Aloke V Finn, Renu Virmani, Frank D Kolodgie
BACKGROUND AND AIMS: Lipoprotein-associated phospholipase A2 (Lp-PLA2), an enzymatic inflammatory biomarker primarily bound to low-density lipoprotein cholesterol, is associated with an approximate twofold increased risk of cardiovascular disease and stroke. Despite indications that circulating Lp-PLA2 is sensitive to statins, it remains largely unknown whether statin usage exerts local effects on Lp-PLA2 expression at the site of atheromatous plaque. METHODS: Carotid plaques (n = 38) were prospectively collected from symptomatic (n = 18) and asymptomatic (n = 20) patients with (n = 20) or without (n = 18) documented statin history...
October 14, 2017: Atherosclerosis
https://www.readbyqxmd.com/read/29097132/cavernous-carotid-stenosis-following-stereotactic-radiosurgery-for-cushing-s-disease-a-rare-complication-and-review-of-the-literature
#15
Mohana Rao Patibandla, Zhiyuan Xu, David Schlesinger, Jason P Sheehan
Intracranial carotid stenosis or occlusion after SRS is an extraordinarily rare event. Because of the rarity of this event, increased awareness within the neurosurgical community is required. For those with post-radiosurgical carotid stenosis who are asymptomatic, longitudinal follow up is recommended. Management depends on whether the patient is symptomatic or asymptomatic. Those who are symptomatic may require balloon angioplasty, stenting, or bypass surgery.
October 30, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/29089414/flow-diversion-for-anterior-choroidal-artery-acha-aneurysms-a-multi-institutional-experience
#16
Visish M Srinivasan, Michael George Zaki Ghali, Jacob Cherian, Maxim Mokin, Ajit S Puri, Ramesh Grandhi, Stephen R Chen, Jeremiah N Johnson, Peter Kan
BACKGROUND: Anterior choroidal artery (AChA) aneurysms represent a small subset of cerebral aneurysms. The Pipeline Embolization Device (PED) has been successfully applied to various aneurysms of the supraclinoid internal carotid artery (ICA). The treatment of these aneurysms requires special attention due to the eloquent territory supplied by the AChA. We report the largest and first dedicated series of flow diversion treatment of AChA aneurysms. METHODS: Four institutional neurointerventional databases were reviewed for cases of intracranial aneurysms treated with PED...
October 31, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29089282/safety-and-efficacy-of-the-new-micromesh-covered-stent-cguard-in-patients-undergoing-carotid-artery-stenting-early-experience-from-a-single-centre
#17
Renato Casana, Valerio Tolva, Andrea Odero, Chiara Malloggi, Aldo Paolucci, Fabio Triulzi, Vincenzo Silani
OBJECTIVE/BACKGROUND: Plaque protrusion through stent struts represents one of the principal causes of cerebral embolisation during carotid artery stenting (CAS) and the stent healing period. The aim of this study was to evaluate the safety (technical success) and efficacy (clinical success) of the CGuard stent system - a new nitinol stent covered by a closed-cell polyethylene terephthalate mesh designed to prevent embolic events. METHODS: Eighty-two consecutive patients who underwent CAS with CGuard from June 2015 were included in this study...
October 28, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/29078025/discrepancy-analysis-between-crystallized-and-fluid-intelligence-tests-a-novel-method-to-detect-mild-cognitive-impairment-in-patients-with-asymptomatic-carotid-artery-stenosis
#18
Akiko Takaiwa, Naoya Kuwayama, Naoki Akioka, Daina Kashiwazaki, Satoshi Kuroda
BACKGROUND AND OBJECTIVE: The present study was conducted to accurately determine the presence of mild cognitive impairment, which is often difficult to evaluate using only simple tests. Our approach focused on discrepancy analysis of fluid intelligence relative to crystallized intelligence using internationally recognized neuropsychological tests. METHODS: One-hundred and five patients diagnosed with asymptomatic carotid artery stenosis were assessed. The neuropsychological tests included the two-subtests (information, picture completion) of Wechsler Adult Intelligence Scale-Revised (WAIS-R-two-subtests): crystallized intelligence tests and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS; immediate memory, visuospatial/-construction, language, attention, delayed memory, and total score) as fluid intelligence tests...
October 27, 2017: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/29076745/cost-effectiveness-of-magnetic-resonance-carotid-plaque-imaging-for-primary-stroke-prevention-in-canada
#19
Lechtman E, Balki I, Thomas K, Chen K, Moody Ar, Tyrrell Pn
OBJECTIVE: Magnetic resonance of the carotid arteries provides important insight into plaque composition and vulnerability in addition to the traditional measure of stenosis. The purpose of this study was to evaluate the cost-effectiveness of MR imaging as a first-line modality to assess carotid disease and guide management for high-risk patients with <50% stenosis. METHODS: Using TreeAge Pro, a cost-effectiveness simulation was conducted comparing two strategies: (a) standard of care first-line carotid duplex ultrasound (DUS) with regular follow-up, vs (b) first-line MR assessment of stenosis and intraplaque haemorrhage (MRIPH) in which patients with IPH received annual DUS surveillance and immediate carotid endarterectomy in case of plaque progression...
November 21, 2017: British Journal of Radiology
https://www.readbyqxmd.com/read/29074624/de-adoption-and-exnovation-in-the-use-of-carotid-revascularization-retrospective-cohort-study
#20
Kimon Bekelis, Jonathan Skinner, Daniel Gottlieb, Philip Goodney
Objective To determine physician characteristics associated with exnovation (scaling back on use) and de-adoption (abandoning use) of carotid revascularization.Design Retrospective longitudinal cohort study.Setting Medicare claims linked to the Doximity database provider registry, 2006-13.Participants 9158 physicians who performed carotid revascularization on Medicare patients between 2006 and 2013.Main outcome measures The primary outcomes were the number of carotid revascularization procedures for each physician per year at the end of the sample period, and the percentage change in the volume of carotid revascularization procedures...
October 26, 2017: BMJ: British Medical Journal
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