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Carotid Stenosis

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https://www.readbyqxmd.com/read/28820309/advanced-cone-beam-ct-venous-angiographic-imaging
#1
Visish M Srinivasan, Gouthami Chintalapani, Edward A M Duckworth, Peter Kan
OBJECTIVE The evaluation of the venous neurovasculature, especially the dural venous sinuses, is most often performed using MR or CT venography. For further assessment, diagnostic cerebral angiography may be performed. Three-dimensional rotational angiography (3D-RA) can be applied to the venous system, producing 3D rotational venography (3D-RV) and cross-sectional reconstructions, which function as an adjunct to traditional 2D digital subtraction angiography. METHODS After querying the database of Baylor St...
August 18, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28818261/contemporary-medical-therapies-of-atherosclerotic-carotid-artery-disease
#2
Suk F Cheng, Martin M Brown
Contemporary medical therapy consists of identification and treatment of all patient-modifiable vascular risk factors. Specific atherosclerotic disease therapies are designed to reduce the risk of thrombosis, and the disease progression in order to reduce the risk of future cardiovascular events. Contemporary medical management emphasizes the need to support the patient in achieving lifestyle modifications and to adjust medication to achieve individualized target values for specific quantifiable risk factors...
March 2017: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28818260/transcranial-doppler-monitoring-for-microemboli-a-marker-of-a-high-risk-carotid-plaque
#3
J David Spence
In the United States, 90% of carotid intervention is being performed for asymptomatic carotid stenosis, even though 90% of patients would be better treated with intensive medical therapy. This is being justified by comparing risks of stroke or death with medical therapy during clinical trials completed decades ago (approximately 2% per year) with risks of intervention with carotid artery stenting (CAS) versus carotid endarterectomy in recent trials that did not have a medical arm. Such extrapolations are, simply put, invalid...
March 2017: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28818258/imaging-of-high-risk-carotid-plaques-ultrasound
#4
Rafael S Cires-Drouet, Mahvash Mozafarian, Amir Ali, Siddhartha Sikdar, Brajesh K Lal
Duplex ultrasonography has a well-established role in the assessment of the degree of stenosis caused by carotid atherosclerosis. This assessment is derived from Doppler velocity changes induced by the narrowing lumen of the artery. New research into the mechanisms for plaque rupture and atheroembolic stroke indicates that the degree of narrowing is an imperfect predictor of stroke risk, and that other factors, such as plaque composition and remodeling and biomechanical forces acting on the plaque, can play a role...
March 2017: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28818257/high-risk-carotid-plaque-lessons-learned-from-histopathology
#5
Frank D Kolodgie, Kazuyuki Yahagi, Hiroyoshi Mori, Maria E Romero, Hugh H Trout, Aloke V Finn, Renu Virmani
The pathophysiology and natural history of atherosclerotic carotid disease is predicated on a more extensive knowledge of lesion progression gained in the studies conducted in the coronary arteries, and these will be reviewed. While the precise sequence of lesion progression leading to carotid plaque vulnerability and cerebrovascular events remain less well understood, specific early and more advanced progressive lesion morphologies associated with stroke risk have been characterized. Of late, there has been a conscious effort for stroke prevention in symptomatic and asymptomatic patients to move beyond luminal stenosis as the only guidance to predict future cerebrovascular events...
March 2017: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28818256/will-mesh-covered-stents-help-reduce-stroke-associated-with-carotid-stent-angioplasty
#6
Carly N Richards, Peter A Schneider
Carotid stent angioplasty (CAS) has been shown to protect patient from future stroke long-term efficacy similar to carotid endarterectomy (CEA). The risk of minor stroke in the perioperative period is higher than with CEA and not related to cerebral protection during the CAS procedure since a significant portion of the neurologic events occur between 1 and 30 days following stent deployment. This observation suggests mechanisms integral to the stent itself may be pertinent such as plaque embolization thru the stent struts may occur...
March 2017: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28818255/clinical-need-design-and-goals-for-the-carotid-revascularization-and-medical-management-for-asymptomatic-carotid-stenosis-trial
#7
Brajesh K Lal, James F Meschia, Thomas G Brott
Prior clinical trials produced evidence-based treatment recommendations for patients with asymptomatic carotid stenosis that may not be appropriate for clinical decision-making today. High-quality patient outcomes data to allow informed decision making regarding the optimal management of high-grade asymptomatic internal carotid artery stenosis is lacking. The results of the Asymptomatic Carotid Atherosclerosis Study were published in 1995 based on a randomized patient enrollment in the 1990s. Outcomes after endarterectomy, stenting, and medical treatment for these patients have all improved in the subsequent 2 decades...
March 2017: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28816615/in-stent-hypodense-area-at-two-weeks-following-carotid-artery-stenting-predicts-neointimal-hyperplasia-after-two-years
#8
Kentaro Yamashita, Jouji Kokuzawa, Tatsuya Kuroda, Satoru Murase, Morio Kumagai, Yasuhiko Kaku
Introduction It has not been reported how long the follow-up study after carotid artery stenting (CAS) should be continued. The purpose of the present study is to clarify the dynamic change of the in-stent neointimal layer and residual arterial lumen by two years following CAS using three-dimensional computed tomography angiography (3D CTA) with volume rendering. Methods Thirty-six stented carotid arteries in 34 consecutive patients were examined by 3D CTA with volume rendering at two weeks and 3, 6, 12, 24 months of follow-up...
January 1, 2017: Neuroradiology Journal
https://www.readbyqxmd.com/read/28816542/the-fate-of-asymptomatic-severe-carotid-stenosis-in-the-era-of-best-medical-therapy
#9
Rodolfo Pini, Gianluca Faggioli, Andrea Vacirca, Laura Maria Cacioppa, Enrico Gallitto, Mauro Gargiulo, Andrea Stella
BACKGROUND: Medical therapy for asymptomatic carotid artery stenosis (ACAS) may obviate the carotid revascularization, according to recent literature reports, but many studies also considered moderate carotid artery stenosis (50-69% NASCET). This study reviews the most recent series of ACAS focusing on ipsilateral transient ischemic attack (TIA) stroke and annual risk of stroke in patients with ACAS ≥70%, thereby also evaluating the adherence to best medical therapy (BMT). METHODS: A systematic review consisting of all the series of patients with ACAS being treated medically was performed, which was published after 2005...
August 17, 2017: Brain Injury: [BI]
https://www.readbyqxmd.com/read/28815338/prolonged-hypotension-after-carotid-artery-stenting-incidence-predictors-and-consequences
#10
Elif Gökçal, Elvin Niftaliyev, Çiğdem Deniz, Mehmet Ergelen, Vildan Güzel, Ömer Göktekin, Talip Asil
BACKGROUND: Hemodynamic changes frequently occur after carotid artery stenting (CAS), and in some patients these changes, particularly hypotension, may be prolonged. There are discrepant results for predicting patients at high risk for these prolonged hemodynamic changes and identifying the effect on clinical outcome. In this study, we aimed to determine the frequency, predictors and consequences associated with prolonged hypotension (PH) after CAS in our center. METHODS: We retrospectively analyzed the demographics, risk factors, nature of carotid disease, degree of stenosis of both internal carotid arteries, stent diameter and site of dilatation during stenting in 137 CAS procedures...
August 17, 2017: Acta Neurochirurgica
https://www.readbyqxmd.com/read/28814168/deterioration-of-heart-rate-recovery-index-in-patients-after-carotid-artery-stenting
#11
Emrah Aytac, Murat Gonen, Orhan Dogdu, Mehmet Balin
Objective Although carotid artery stenting (CAS) is an effective treatment for severe carotid stenosis, it has been associated with alterations in autonomic functions long term after the procedure. Patients with CAS have been reported to have autonomic nervous system (ANS) dysfunction. This study aimed to evaluate heart rate recovery (HRR) indices and exercise test parameters after CAS. Methods Patients (10 male, 11 female) suitable for CAS, without a history of hypertension, diabetes mellitus, severe coronary artery or valvular heart disease, were enrolled in our study...
January 1, 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/28814167/cardio-cephalic-neural-crest-syndrome-a-novel-hypothesis-of-vascular-neurocristopathy
#12
M Komiyama
A novel hypothesis proposes that "cardio-cephalic neural crest (NC) syndrome," i.e. cephalic NC including cardiac NC, contributes to the concurrent occurrence of vascular diseases in the cardio- and cerebrovascular regions. NC is a transient structure present in early embryogenesis. Cephalic NC provides mesenchymal cells to the vascular media in these regions. Concurrent cardio- and cerebrovascular lesions have been reported in PHACE syndrome, ACTA2 mutation syndrome, and less frequently in the spontaneous occlusion of the circle of Willis (so-called moyamoya disease)...
January 1, 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/28813583/carotid-artery-stenosis-although-military-physicians-operate-less-they-achieve-better-outcomes
#13
Arthur L Kellermann
No abstract text is available yet for this article.
August 16, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28805764/-behavioral-phenotyping-in-rats-during-the-experimental-modeling-of-chronic-cerebral-circulation-disorder
#14
D V Kurkin, E I Morkovin, D V Verkholiak, N A Osadchenko, I N Tyurenkov, V I Petrov
AIM: To describe motor, adaptive and cognitive disorders in rats with chronic cerebral circulatory deficiency caused by partial stenosis of the common carotid arteries (CCA). MATERIAL AND METHODS: A study was performed on 20 white outbred male rats. This manipulation led to 40-45% and 50-60% reduction of blood flow in CCA and in the brain, respectively. Twenty days after operation, animal's condition was assessed in the following tests: open field test, rotarod performance test, marble burying test and novel object recognition...
2017: Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova
https://www.readbyqxmd.com/read/28804624/carotid-endarterectomy-for-in-stent-restenosis-a-case-report-and-literature-review
#15
Baofeng Xu, Rui Liu, Liqun Jiao, Jinlu Yu
It is relatively difficult to treat restenosis when restenosis occurs following carotid artery stenting. Endarterectomy with simultaneous stent removal is an effective approach when restenosis occurs. The treatment method is still not well known. The present paper reports a case of restenosis after stenting that was treated with endarterectomy with a satisfactory treatment outcome. The patient, a 74-year-old male, underwent stenting 10 months before he was re-hospitalized. He seemed to recover well after stenting until one month before he was re-hospitalized, when he presented symptoms of cerebral ischemia...
August 2017: Biomedical Reports
https://www.readbyqxmd.com/read/28801300/-carotid-artery-stenosis-treated-with-modified-carotid-endarterectomy-report-of-two-cases
#16
Zheng-Jun Liu, Jing-Bo Lu, Hao Liu, Zhi-Qi Lin, Xian-Ying Huang, Heng Wan, Fang-Yong Fu, Shui-Chuan Huang
Based on standard carotid endarterectomy, we performed modified carotid endarterectomy in two cases of carotid artery stenosis by changing the direction of the carotid artery incision to avoid restenosis of the internal carotid artery without using a patch. The two patients recovered smoothly without any complications. Compared with eversion or patch endarterectomy, this modified carotid endarterectomy avoids restenosis of the carotid artery and shortens operation time.
August 20, 2017: Nan Fang Yi Ke da Xue Xue Bao, Journal of Southern Medical University
https://www.readbyqxmd.com/read/28798867/effect-of-intraplaque-angiogenesis-to-atherosclerotic-rupture-prone-plaque-induced-by-high-shear-stress-in-rabbit-model
#17
Juhui Qiu, Daoxi Lei, Jianjun Hu, Tieying Yin, Kang Zhang, Donghong Yu, Guixue Wang
Atherosclerotic prone-rupture plaque is mainly localized in the region of the entrance to the stenosis with high shear stress and the reasons are largely unknown. Our hypothesis is that such a distribution of cells in atherosclerotic plaque may depend on the angiogenesis. Silastic collars induced regions of high shear stress (20.68 ± 5.27 dynes/cm(2)) in the upstream flow and low shear stress (12.25 ± 1.28 dynes/cm(2)) in the downstream flow in carotid arteries. Compared with the low shear stress region, plaques in the high shear stress region showed more intraplaque haemorrhaging, less collagen and higher apoptotic rates of vascular smooth muscle cells; endothelial cells (ECs) in the high shear stress region were characterized with integrity and high endothelial nitric oxide synthase (eNOS) expression (1570...
August 2017: Regenerative Biomaterials
https://www.readbyqxmd.com/read/28798785/simultaneous-vertebral-and-subclavian-artery-stenting
#18
Damian R Maciejewski, Łukasz Tekieli, Roman Machnik, Anna Kabłak-Ziembicka, Tadeusz Przewłocki, Piotr Paluszek, Mariusz Trystuła, Robert Musiał, Karolina Dzierwa, Piotr Pieniążek
INTRODUCTION: Vertebrobasilar territory ischemia leads to disabling neurological symptoms and may be caused both by vertebral artery (VA) and subclavian artery (SA) stenosis. The coexisting symptomatic ipsilateral VA and proximal SA stenosis should be considered as a true bifurcation lesion for percutaneous treatment. AIM: To evaluate the safety and efficacy of simultaneous angioplasty of vertebral and subclavian stenosis. MATERIAL AND METHODS: Fifteen patients (age 69...
2017: Postępy W Kardiologii Interwencyjnej, Advances in Interventional Cardiology
https://www.readbyqxmd.com/read/28798783/mesh-covered-roadsaver-stent-as-a-new-treatment-modality-for-symptomatic-or-high-risk-carotid-stenosis
#19
Roman Machnik, Piotr Paluszek, Łukasz Tekieli, Karolina Dzierwa, Damian Maciejewski, Mariusz Trystuła, Andrzej Brzychczy, Krzysztof Banaszkiewicz, Robert Musiał, Piotr Pieniążek
INTRODUCTION: Prevention of periprocedural stroke has a crucial role in carotid artery stenting (CAS) procedures. AIM: To assess retrospectively 30-day safety and effectiveness of 41 procedures of internal and common carotid artery stenting using the Roadsaver double nitinol layer micromesh stent in 40 non-consecutive patients with symptomatic or high-risk carotid artery stenosis. MATERIAL AND METHODS: The patients were men (n = 31) and women (n = 9); mean age was 67...
2017: Postępy W Kardiologii Interwencyjnej, Advances in Interventional Cardiology
https://www.readbyqxmd.com/read/28798779/one-swallow-does-not-a-summer-make-but-many-swallows-do-accumulating-clinical-evidence-for-nearly-eliminated-peri-procedural-and-30-day-complications-with-mesh-covered-stents-transforms-the-carotid-revascularisation-field
#20
REVIEW
Piotr Musiałek, L Nelson Hopkins, Adnan H Siddiqui
Atherosclerotic carotid artery stenosis (CS) continues to be a common cause of acute ischaemic stroke. Optimised medical therapy (OMT), the first-line treatment modality in CS, may reduce or delay - but it does not abolish - CS-related strokes. As per current AHA/ASA and ESC/ESVS/ESO guidelines, carotid artery stenting (CAS) is a less-invasive alternative to carotid endarterectomy (CEA) for CS revascularisation in primary and secondary stroke prevention. Ten-year follow-up from the CREST trial in patients with symptomatic and asymptomatic CS confirmed equipoise of CAS and CEA in the primary endpoint...
2017: Postępy W Kardiologii Interwencyjnej, Advances in Interventional Cardiology
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