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Carotid Stenosis

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https://www.readbyqxmd.com/read/29163956/eversion-endarterectomy-under-full-prasugrel-treatment
#1
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/29163747/endovascular-stenting-of-tandem-carotid-artery-origin-and-bifurcation-stenotic-lesions-using-flow-reversal
#2
Andrew A Fanous, Parham Yashar, Ashish Sonig, Amanda Zakeri, Kenneth V Snyder, Elad I Levy, Jason M Davies, Adnan H Siddiqui
Background: The treatment of tandem lesions involving severe stenosis of the internal carotid artery with concomitant stenosis of the ipsilateral common carotid artery (CCA) origin represents an ongoing challenge. Current options for the treatment of tandem carotid artery origin and bifurcation stenotic lesions include open surgical endarterectomy, endovascular stenting, balloon angioplasty, and hybrid procedures combining both modalities. However, these options are either associated with high peri-operative risks or not always anatomically feasible...
October 2017: Journal of Vascular and Interventional Neurology
https://www.readbyqxmd.com/read/29163214/predictive-value-of-dynamic-cerebral-autoregulation-assessment-in-surgical-management-of-patients-with-high-grade-carotid-artery-stenosis
#3
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/29154281/gradual-cerebral-hypoperfusion-impairs-fear-conditioning-and-object-recognition-learning-and-memory-in-mice-potential-roles-of-neurodegeneration-and-cholinergic-dysfunction
#4
Jogender Mehla, Sean Lacoursiere, Emily Stuart, Robert J McDonald, Majid H Mohajerani
In the present study, male C57BL/6J mice were subjected to gradual cerebral hypoperfusion by implanting an ameroid constrictor (AC) on the left common carotid artery (CCA) and a stenosis on the right CCA. In the sham group, all surgical procedures were kept the same except no AC was implanted and stenosis was not performed. One month following the surgical procedures, fear conditioning and object recognition tests were conducted to evaluate learning and memory functions and motor functions were assessed using a balance beam test...
November 14, 2017: Journal of Alzheimer's Disease: JAD
https://www.readbyqxmd.com/read/29153440/relationship-between-adamts4-and-carotid-atherosclerotic-plaque-vulnerability-in-humans
#5
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/29153302/accuracy-of-carotid-duplex-criteria-in-diagnosis-of-significant-carotid-stenosis-in-asian-patients
#6
Pornpatr A Dharmasaroja, Nattaphol Uransilp, Arvemas Watcharakorn, Pritsana Piyabhan
BACKGROUND: Extracranial carotid stenosis can be diagnosed by velocity criteria of carotid duplex. Whether they are accurately applied to define severity of internal carotid artery (ICA) stenosis in Asian patients needs to be proved. The purpose of this study was to evaluate the accuracy of 2 carotid duplex velocity criteria in defining significant carotid stenosis. METHODS: Carotid duplex studies and magnetic resonance angiography were reviewed. Criteria 1 was recommended by the Society of Radiologists in Ultrasound; moderate stenosis (50%-69%): peak systolic velocity (PSV) 125-230 cm/s, diastolic velocity (DV) 40-100 cm/s; severe stenosis (>70%): PSV greater than 230 cm/s, DV greater than 100 cm/s...
November 16, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29149815/stroke-and-hypertension-an-appraisal-from-pathophysiology-to-clinical-practice
#7
Agata Buonacera, Benedetta Stancanelli, Lorenzo Malatino
Stroke as a cause of long-term disability is a growing public health burden. Therefore, focusing on prevention is important. The most prominent aim of this strategy is to treat modifiable risk factors, such as arterial hypertension, the leading modifiable contributor to stroke. Thus, efforts to adequately reduce blood pressure (BP) among hypertensives are mandatory. In this respect, although safety and benefits of BP control related to long-term outcome have been largely demonstrated, there are open questions that remain to be addressed, such as optimal timing to initiate BP reduction and BP goals to be targeted...
November 16, 2017: Current Vascular Pharmacology
https://www.readbyqxmd.com/read/29146719/can-arterial-spin-labeling-with-multiple-postlabeling-delays-predict-cerebrovascular-reserve
#8
H J Choi, C-H Sohn, S-H You, R-E Yoo, K M Kang, T J Yun, S H Choi, J-H Kim, W-S Cho, J E Kim
BACKGROUND AND PURPOSE: The effect of delayed transit time is the main source of error in the quantitative measurement of CBF in arterial spin-labeling. In the present study, we evaluated the usefulness of the transit time-corrected CBF and arterial transit time delay from multiple postlabeling delays arterial spin-labeling compared with basal/acetazolamide stress technetium Tc99m-hexamethylpropylene amineoxime (Tc99m-HMPAO) SPECT in predicting impairment in the cerebrovascular reserve...
November 16, 2017: AJNR. American Journal of Neuroradiology
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/29136204/thrombolysis-is-an-independent-risk-factor-for-poor-outcome-after-carotid-revascularization
#11
Ananth K Vellimana, Chad W Washington, Chester K Yarbrough, Thomas K Pilgram, Brian L Hoh, Colin P Derdeyn, Gregory J Zipfel
BACKGROUND: Thrombolysis is the standard of care for acute ischemic stroke patients presenting in the appropriate time window. Studies suggest that the risk of recurrent ischemia is lower if carotid revascularization is performed early after the index event. The safety of early carotid revascularization in this patient population is unclear. OBJECTIVE: To evaluate the safety of carotid revascularization in patients who received thrombolysis for acute ischemic stroke...
November 10, 2017: Neurosurgery
https://www.readbyqxmd.com/read/29135355/changes-in-ocular-hemodynamics-after-carotid-artery-angioplasty-and-stenting-caas-in-patients-with-different-severity-of-ocular-ischemic-syndrome
#12
Feiyan Ma, Jing Su, Qingli Shang, Jingxue Ma, Tongdi Zhang, Xin Wang, Honglei Ma, Jianghua Yu
PURPOSE: To evaluate the effects of carotid artery angioplasty and stenting (CAAS) on patients who were diagnosed with ocular ischemic syndrome (OIS). METHODS: Sixty-four eyes of 64 OIS patients with ipsilateral internal carotid artery stenosis ≥70% were included in the study. The study eyes were divided into two groups according to the presence of iris neovascularization: NVI-absent group and NVI-present group, with 32 eyes, respectively. All patients received ocular treatment modality according to the presence of non-perfusion area (pan-retinal photocoagulation) and intraocular pressure (medical treatment included timolol maleate eye drops combined with brinzolamide eye drop; trabeculectomy and cyclophotocoagulation)...
November 14, 2017: Current Eye Research
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
#13
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/29132058/clinical-significance-of-the-coexistence-of-carotid-artery-plaque-and-white-matter-disease-in-patients-with-symptomatic-cerebral-infarction
#14
Mami Ishikawa, Hitoshi Sugawara, Toshiyuki Tsuji, Mutsumi Nagai, Gen Kusaka, Heiji Naritaka
OBJECTIVES: Symptomatic cerebral infarction (CI) can occur in patients without main cerebral artery stenosis or occlusion. This study investigated the unique features of carotid artery plaque and white matter disease (WMD) in patients with symptomatic CI and transient ischemic attack (TIA) but without stenosis or occlusion of a main cerebral artery. PATIENTS AND METHODS: We studied 647 patients who underwent both carotid ultrasound examination and brain magnetic resonance images...
December 2017: Clinical Neurology and Neurosurgery
https://www.readbyqxmd.com/read/29131102/a-case-of-a-4-year-old-female-with-a-primary-spinal-malignancy-presenting-with-froin-s-syndrome
#15
Andrew T Hale, Gregory P Fricker, Travis W Crook
We report the case of a 4-year-old female with a primary extradural intramedullary atypical teratoid/rhabdoid tumor (AT/RT) leading to a middle cerebral artery (MCA) infarct and Froin's syndrome. She presented with a 6-pound weight loss over the previous week, as well as a decreased urinary output and an altered mental status. She underwent a brain MRI that revealed a left MCA infarct, mild ventriculomegaly, and bilateral internal carotid artery, M1, and A1 stenosis. An external ventricular drain (EVD) was placed due to increased intracranial pressure...
November 2, 2017: Pediatric Neurosurgery
https://www.readbyqxmd.com/read/29130668/-analysis-on-clinical-characteristic-and-risk-factors-of-patients-coexistence-of-cerebral-artery-stenosis-with-unruptured-intracranial-aneurysm
#16
Hai-Yan Zhao, Jin-Tao Han, Dong-Sheng Fan
OBJECTIVE: To analyze the incidence of intracranial unruptured aneurysms in patients with intracranial artery stenosis,clinical features,and investigate the risk factors for unruptured intracranial aneurysms. METHODS: Medical records from all patients performed with digital subtraction angiography (DSA) who had been treated at Peking University Third Hospital,China,from January 2012 to December 2015 were retrospectively reviewed to identify cases coexistence with cerebral artery stenosis and unruptured intracranial aneurysm...
September 2017: Sichuan da Xue Xue Bao. Yi Xue Ban, Journal of Sichuan University. Medical Science Edition
https://www.readbyqxmd.com/read/29130563/serum-lipoprotein-and-rbc-rigidity-index-to-predict-cerebral-infarction-in-patients-with-carotid-artery-stenosis
#17
Zhiwu Dong, Qiang Guo, Li Sun, Feifei Li, Aihong Zhao, Jingfan Liu, Peipei Qu, Qinghua Zhu, Chunhai Xiao, Fusheng Niu, Shuang Liang
OBJECTIVE: This study aims to determine the risk factors and to predict the occurrence of cerebral infarction in patients with carotid artery stenosis. METHODS: Two hundred and one subjects with carotid artery stenosis were retrospectively selected from Jinshan Branch of Shanghai Sixth People's Hospital, 115 cases of which with cerebral infarction and 86 without it. Clinical tests were performed including coagulation indices, fasting glucose, serum lipid, and blood rheology...
November 11, 2017: Journal of Clinical Laboratory Analysis
https://www.readbyqxmd.com/read/29117648/serum-neuron-specific-enolase-as-a-marker-of-brain-ischemia-reperfusion-injury-in-patients-undergoing-carotid-endarterectomy
#18
Marek Iłżecki, Joanna Iłżecka, Stanisław Przywara, Piotr Terlecki, Aneta Grabarska, Andrzej Stepulak, Tomasz Zubilewicz
In patients with atherosclerotic stenosis of the extracranial segment of internal carotid artery, surgical intervention is an effective method to prevent cerebral ischemic stroke. However, this surgical procedure may cause vascular brain damage. The aim of the study was to investigate consequential brain ischemia-reperfusion injury by measuring the cerebral specific marker, neuron-specific (NSE), in serum of patients having undergone internal carotid endarterectomy (CEA). The study involved 25 patients that underwent CEA due to internal carotid artery stenosis...
December 2016: Acta Clinica Croatica
https://www.readbyqxmd.com/read/29117272/risks-associated-with-primary-and-redo-carotid-endarterectomy-in-the-endovascular-era
#19
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/29114096/fingolimod-protects-against-ischemic-white-matter-damage-by-modulating-microglia-toward-m2-polarization-via-stat3-pathway
#20
Chuan Qin, Wen-Hui Fan, Qian Liu, Ke Shang, Madhuvika Murugan, Long-Jun Wu, Wei Wang, Dai-Shi Tian
BACKGROUND AND PURPOSE: White matter (WM) ischemic injury, a major neuropathological feature of cerebral small vessel diseases, is an important cause of vascular cognitive impairment in later life. The pathogenesis of demyelination after WM ischemic damage are often accompanied by microglial activation. Fingolimod (FTY720) was approved for the treatment of multiple sclerosis for its immunosuppression property. In this study, we evaluated the neuroprotective potential of FTY720 in a WM ischemia model...
November 7, 2017: Stroke; a Journal of Cerebral Circulation
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