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Asymptomatic carotid stenosis

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https://www.readbyqxmd.com/read/29019319/the-asymptomatic-carotid-surgery-trial-2-acst-2-an-ongoing-randomised-controlled-trial-comparing-carotid-endarterectomy-with-carotid-artery-stenting-to-prevent-stroke
#1
Richard Bulbulia, Alison Halliday
BACKGROUND: A successful open surgical operation to remove atheromatous carotid artery narrowing that has not yet caused a stroke (asymptomatic carotid stenosis) carries some procedural risk but, if completed successfully, halves patients' future annual stroke risk for at least 10 years. A newer, less invasive alternative is carotid stenting, which also carries some procedural risk, especially if the carotid lesion has recently given rise to a stroke (symptomatic carotid stenosis). For both surgery and stenting, improvements in technique (and in medication) have reduced risk...
October 2017: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/28987721/circulating-inflammation-resolving-lipid-mediators-rvd1-and-dha-are-decreased-in-patients-with-acutely-symptomatic-carotid-disease
#2
Hernan A Bazan, Yan Lu, Bokkyoo Jun, Zhide Fang, T Cooper Woods, Song Hong
BACKGROUND: Efficient biomarkers for early prediction and diagnosis of an acutely symptomatic carotid plaque rupture event are currently lacking, impairing the ability to diagnose and treat patients with an acute plaque rupture events in a timely fashion. Resolvins are endogenous inflammation-resolving lipid mediators that are induced by inflammatory insults. We hypothesized that resolvin and other lipid profiles in sera likely mark the process towards plaque rupture. METHODS: Circulating lipids associated with plaque rupture events were quantitatively profiled via targeted mediator-lipidomics using ultraperformance liquid chromatography tandem mass spectrometry in patients with acutely symptomatic and asymptomatic carotid disease...
October 2017: Prostaglandins, Leukotrienes, and Essential Fatty Acids
https://www.readbyqxmd.com/read/28985661/surgical-treatment-of-significant-asymptomatic-carotid-stenosis-for-the-motion
#3
Daniela Mazzaccaro, Giovanni Romagnoni, Alberto Maria Settembrini, Giovanni Nano
No abstract text is available yet for this article.
October 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28982691/carotid-stent-fractures-are-not-associated-with-adverse-events-results-from-the-act-1-multicenter-randomized-trial
#4
Ido Weinberg, Joshua A Beckman, Jon S Matsumura, Kenneth Rosenfield, Gary Ansel, Seemant Chaturvedi, William A Gray, D Chris Metzger, Tom S Riles, Yu Shu, Lawrence R Wechsler, Michael R Jaff
Background -The impact of carotid artery stent fractures on the incidence of adverse clinical events remains unclear. The objective of this study is to report the stent fracture rate and its association with in-stent restenosis and adverse outcomes in the Asymptomatic Carotid Trial (ACT)-1. Methods -ACT-1 is a prospective multicenter trial of standard surgical risk patients with severe asymptomatic carotid artery stenosis randomized to carotid artery stenting (CAS) or carotid endarterectomy (CEA) (Abbott Vascular, Santa Clara, California, USA)...
October 5, 2017: Circulation
https://www.readbyqxmd.com/read/28977565/transcarotid-transcatheter-aortic-valve-implantation-multicentre-experience-in-france
#5
Thierry Folliguet, Nicolas Laurent, Maxime Bertram, Konstantinos Zannis, Mazen Elfarra, Fabrice Vanhuyse, Pablo Maureira, Thomas Modine
OBJECTIVES: Transcatheter aortic valve implantation is a well-recognized treatment option for high-risk patients with aortic stenosis. The femoral approach is possible in 80% of cases and remains the access of choice. When this approach is not feasible, other alternative routes have been proposed such as transapical, transaortic and subclavian. Transcarotid aortic valve implantation has been proposed as another direct vascular access. Its use is relatively new and still under evaluation...
August 4, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28973212/should-we-screen-this-patient-for-carotid-artery-stenosis-grand-rounds-discussion-from-beth-israel-deaconess-medical-center
#6
Gerald W Smetana, Marc Schermerhorn, Kenneth J Mukamal
In July 2014, the U.S. Preventive Services Task Force (USPSTF) published a clinical guideline on screening for asymptomatic carotid artery stenosis. The guideline recommended against screening in asymptomatic adults, based primarily on the results of 3 large randomized trials (grade D recommendation). The principal screening test was carotid ultrasonography, and the intervention in the 3 trials was carotid endarterectomy for patients with stenosis exceeding 50% to 60%. In a meta-analysis, carotid endarterectomy reduced rates of 1) perioperative stroke, death, or subsequent ipsilateral stroke and 2) perioperative stroke, death, or any subsequent stroke...
October 3, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28964389/-contribution-of-contrast-enhanced-ultrasonography-in-the-characterization-of-carotid-lesions
#7
J M Baud, S Luong, O Rouyer, A Maurizot, C Gautier
Harmonic mode ultrasound with injection of a contrast enhancement agent allows visualization of mobile microbubbles in the carotid plaque corresponding to neovessels secondary to an inflammation or hypoxia. These neovessels could be considered "precursor" markers of the vulnerable plaque. The aim of this work was to give an update on ultrasound contrast imaging acquisition in the exploration of carotid artery both for atheromatous lesions and for large vessel vasculitis. A precise description of the material to be used, the image acquisition methodology and the environmental conditions is discussed, emphasizing the pitfalls to be avoided as well as proper image interpretation...
October 2017: J Med Vasc
https://www.readbyqxmd.com/read/28964386/-cerebral-vasoreactivity-concordance-of-breath-holding-test-and-acetazolamide-injection-in-current-practice-20-cases-of-asymptomatic-carotid-artery-stenosis
#8
M De Bortoli, A Maillet, S Skopinski, G Sassoust, J Constans, C Boulon
INTRODUCTION: Cerebral vasoreactivity (CVR) is the ability of the brain's vascular system to keep cerebral blood inflow stable. Impaired CVR is a risk marker of stroke in patients with asymptomatic carotid stenosis. The gold standard to assess CVR with transcranial ultrasound is acetazolamide (ACTZ) injection. The breath holding test (BHT) might be easier to perform. CVR proved to be efficient in laboratory conditions but not in routine practice. OBJECTIVES: To study the validity of BHT versus ACTZ in routine practice in a vascular exploration unit in patients with asymptomatic carotid stenosis...
October 2017: J Med Vasc
https://www.readbyqxmd.com/read/28959483/carotid-stenosis-in-women-time-for-a-reappraisal
#9
REVIEW
Erika Marulanda-Londoño, Seemant Chaturvedi
The treatment approach for patients with internal carotid artery stenosis is receiving increased scrutiny. Major advances in optimal medical therapy have been associated with a declining stroke rate for symptomatic and asymptomatic patients with carotid stenosis. Customising treatment according to gender is worthy of consideration, since earlier clinical trials showed reduced benefit with carotid endarterectomy in women compared to men. In this review, clinical trial results in women are summarised, studies pertaining to carotid plaque imaging in men and women are discussed and new clinical trials are identified...
December 2016: Stroke and Vascular Neurology
https://www.readbyqxmd.com/read/28943008/development-and-validation-of-a-score-to-predict-life-expectancy-after-carotid-endarterectomy-in-asymptomatic-patients
#10
Michele Carmo, Iacopo Barbetta, Daniele Bissacco, Santi Trimarchi, Vincenzo Catanese, Matteo Bonzini, Stefano Bonardelli, Piergiorgio G Settembrini
OBJECTIVE: Recent improvement of best medical treatment for carotid stenosis has sparked a debate on the role of surgery identification of patients who may benefit from carotid endarterectomy (CEA) is crucial to avoid overtreatment. An expected 5-year postoperative survival is one of the main selection criteria. The aim of this study was the development of a score for predicting survival of asymptomatic patients after CEA. METHODS: Our score was derived from a retrospective analysis of 648 consecutive asymptomatic patients from a single hospital...
September 21, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28935292/clinical-significance-of-reversal-of-flow-in-the-vertebral-artery-identified-on-cerebrovascular-duplex-ultrasound
#11
Aleksandra Policha, Melissa Baldwin, Victoria Lee, Mark A Adelman, Caron Rockman, Todd Berland, Neal S Cayne, Thomas S Maldonado
BACKGROUND: Reversal of flow in the vertebral artery (RFVA) is an uncommon finding on cerebrovascular duplex ultrasound examination. The clinical significance of RFVA and the natural history of patients presenting with it are poorly understood. Our objective was to better characterize the symptoms and outcomes of patients presenting with RFVA. METHODS: A retrospective review was performed of all cerebrovascular duplex ultrasound studies performed at our institution between January 2010 and January 2016 (N = 2927 patients)...
September 18, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28925313/hemodynamics-and-oxygen-extraction-in-chronic-large-artery-steno-occlusive-disease-clinical-applications-for-predicting-stroke-risk
#12
Colin P Derdeyn
Depending on the adequacy of collateral sources of blood flow, arterial stenosis or occlusion may lead to reduced perfusion pressure and ultimately reduced blood flow in the distal territory supplied by that vessel. There are two well-defined compensatory mechanisms to reduced pressure or flow - autoregulatory vasodilation and increased oxygen extraction fraction. Other changes, such as metabolic downregulation, are likely. The positive identification of autoregulatory vasodilation and increased oxygen extraction fraction in humans is an established risk factor for future ischemic stroke in some disease states such as atherosclerotic carotid stenosis and occlusion...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/28919313/periprocedural-outcomes-of-carotid-artery-stenting-in-elderly-patients
#13
Masataka Nanto, Yudai Goto, Hiroyuki Yamamoto, Seisuke Tanigawa, Michiko Takado, Takahiro Ogawa, Yoshikazu Nakahara
BACKGROUND: Carotid artery stenting has emerged as an alternative to carotid endarterectomy especially in patients with high risk of carotid endarterectomy. Older age (≥80 years old) was recognized as one of the high risk factors of carotid endarterectomy. However, the association between older age and increased risk of adverse events for carotid artery stenting has been reported. The purpose of this study was to evaluate the association between age and periprocedural outcomes after carotid artery stenting...
September 14, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28916863/intracerebral-hemorrhage-as-a-manifestation-of-cerebral-hyperperfusion-syndrome-after-carotid-revascularization-systematic-review-and-meta-analysis
#14
REVIEW
Pedro Abreu, Jerina Nogueira, Filipe Brogueira Rodrigues, Ana Nascimento, Mariana Carvalho, Ana Marreiros, Hipólito Nzwalo
BACKGROUND: Intracerebral hemorrhage (ICH) in the context of cerebral hyperperfusion syndrome (CHS) is an uncommon but potentially lethal complication after carotid revascularization for carotid occlusive disease. Information about its incidence, risk factors and fatality is scarce. Therefore, we aimed to perform a systematic review and meta-analysis focusing on the incidence, risk factors and outcomes of ICH in the context of CHS after carotid revascularization. METHODS: We searched the PubMed and EBSCO hosts for all studies published in English about CHS in the context of carotid revascularization...
September 15, 2017: Acta Neurochirurgica
https://www.readbyqxmd.com/read/28916669/asymptomatic-carotid-stenosis-in-cardiac-surgery-patients-is-less-more
#15
EDITORIAL
Rebecca F Gottesman
No abstract text is available yet for this article.
October 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28916664/safety-of-simultaneous-coronary-artery-bypass-grafting-and-carotid-endarterectomy-versus-isolated-coronary-artery-bypass-grafting-a-randomized-clinical-trial
#16
RANDOMIZED CONTROLLED TRIAL
Christian Weimar, Konstantinos Bilbilis, Jan Rekowski, Torulv Holst, Friedhelm Beyersdorf, Martin Breuer, Manfred Dahm, Anno Diegeler, Arne Kowalski, Sven Martens, Friedrich W Mohr, Jiri Ondrášek, Beate Reiter, Peter Roth, Ralf Seipelt, Markus Siggelkow, Gustav Steinhoff, Anton Moritz, Mathias Wilhelmi, Gerhard Wimmer-Greinecker, Hans-Christoph Diener, Heinz Jakob, Claudia Ose, Andre Scherag, Stephan C Knipp
BACKGROUND AND PURPOSE: The optimal operative strategy in patients with severe carotid artery disease undergoing coronary artery bypass grafting (CABG) is unknown. We sought to investigate the safety and efficacy of synchronous combined carotid endarterectomy and CABG as compared with isolated CABG. METHODS: Patients with asymptomatic high-grade carotid artery stenosis ≥80% according to ECST (European Carotid Surgery Trial) ultrasound criteria (corresponding to ≥70% NASCET [North American Symptomatic Carotid Endarterectomy Trial]) who required CABG surgery were randomly assigned to synchronous carotid endarterectomy+CABG or isolated CABG...
October 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28895997/-elevated-incidence-of-cognitive-impairment-in-patients-with-asymptomatic-carotid-stenosis
#17
E Hernandez-Rodriguez, E Sirumal, P J Perez-Lorensu, J L Perez-Burkhardt, J Barroso, I Galtier
INTRODUCTION: Stroke is one of the main causes of mortality and functional disability in developed countries. Carotid stenosis (CS) is considered the reason for 20-30% of strokes. However, the studies that have gone into depth on the cognitive status of these patients are limited. AIM: To investigate the cognitive performance of CS patients and its relationship with clinical variables (carotid obstruction, lifestyle). PATIENTS AND METHODS: 33 CS patients were evaluated using a broad neuropsychological protocol, and were divided into two groups: symptomatic CS and asymptomatic CS...
September 16, 2017: Revista de Neurologia
https://www.readbyqxmd.com/read/28893482/comparison-of-early-outcomes-and-restenosis-rate-between-carotid-endarterectomy-and-carotid-artery-stenting-using-propensity-score-matching-analysis
#18
Seon-Hee Heo, Kyoung-Won Yoon, Shin-Young Woo, Yang-Jin Park, Young-Wook Kim, Keon-Ha Kim, Chin-Sang Chung, Oh-Young Bang, Dong-Ik Kim
OBJECTIVE/BACKGROUND: Despite randomised evidence, the debate continues about the preferred treatment strategy for carotid stenosis in routine clinical practice. The aim of this study was to compare early outcomes and restenosis rates after carotid endarterectomy (CEA) and carotid stenting (CAS) in unselected patients using propensity score matching (PSM). METHODS: The 30 day incidence of major adverse clinical events (MACE; defined as stroke, transient ischaemic attack, myocardial infarction, or death) and procedure related complications, as well as restenosis rates during follow-up were compared between unselected patients undergoing CEA or CAS between January 2002 and December 2015 at a single institution...
September 8, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28890012/ethnicity-race-and-post-operative-stroke-risk-among-53-593-patients-with-asymptomatic-carotid-stenosis-undergoing-revascularization
#19
Roxanna M Garcia, Seungwon Yoon, Tene Cage, Matthew B Potts, Michael T Lawton
BACKGROUND: The incidence of post-operative stroke following carotid endarterectomy is an uncommon event and differences by racial and ethnic subgroups are not fully described in the literature. OBJECTIVE: To investigate the impact of race and ethnicity on post-operative stroke risk among patients with asymptomatic carotid stenosis undergoing carotid endarterectomy. METHODS: The ACS-NSQIP database between 2008 and 2015 was used to identify patients undergoing carotid endarterectomy with no stroke history...
September 7, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28884722/-severe-carotid-stenosis-cerebral-autoregulation-in-the-ipsilateral-region
#20
V B Semenyutin, G А Asaturyan, А А Nikiforova, G К Panuntsev, V A Aliev, V B Iblyaminov, A V Savello, А Patzak, K V Laptev, I P Dudanov, О А Pavlov
AIM: To study cerebral autoregulation (CA) in region of the stenotic carotid artery. MATERIAL AND METHODS: The study involved 35 patients with critical stenosis of the carotid arteries, including 24 patients were asymptomatic and 11 patients with symptomatic course. Blood flow velocity in middle cerebral arteries was monitored using Multi Dop X (DWL, Germany) with simultaneous noninvasive systemic blood pressure registration (CNAP, Austria). CA was assessed by calculating the phase shift (PS) between spontaneous oscillations of blood flow velocity and blood pressure within the range of systemic Mayer waves (80-120 mHz)...
2017: Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova
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